Castleport Test Prep

RRT vs CRT: What's the Difference?

RRT (Registered Respiratory Therapist) is the higher credential; CRT (Certified Respiratory Therapist) is the entry-level one. Both come from the National Board for Respiratory Care (NBRC).

CRT vs RRT at a glance

Comparison point CRT RRT
Level Entry level. NBRC describes its exam as measuring what's required "at entry into practice." Advanced. NBRC calls it the "standard of excellence."
Who awards it NBRC NBRC
Education (standard route) At least an associate degree from an entry-into-practice respiratory therapy program supported or accredited by the Commission on Accreditation for Respiratory Care (CoARC) The same. No extra degree is required.
How you earn it through Dec 31, 2026 Pass the Therapist Multiple-Choice (TMC) exam at the low cut score Pass the TMC at the high cut score (92 or above), meet CSE admission requirements, then pass the Clinical Simulation Exam (CSE)
New RT exam route from Jan 4, 2027 Pass the RT Examination at the low cut score Pass the same RT Examination at the high cut score. No separate CSE.
First-attempt exam fees TMC $190 (160 questions, 3 hours). From 2027: RT exam $360 (185 questions, 4 hours) TMC $190 + CSE $200 (22 problems, 4 hours) = $390. From 2027: one RT exam, $360
New state licenses Accepted for some licensing routes; state and applicant-history rules vary Required for some new-license routes; exceptions and effective dates vary (see the state table below)
Specialty credentials Sleep Disorders Specialty after 6 months as a CRT, or through a qualifying sleep add-on program; Pulmonary Function exam open Sleep Disorders Specialty after 3 months as an RRT, or through a qualifying sleep add-on program; Pulmonary Function, Neonatal/Pediatric, and Adult Critical Care (the last requires RRT for at least 1 year)
Keeping it NBRC Credential Maintenance Program, 5-year term for credentials earned on or after July 1, 2002; earlier credentials have different terms Same date distinction. Earning the RRT doesn't remove your CRT.

Sources: NBRC Candidate Handbook, pp. 4–6 and 8; CRT, CSE, and RT Examination rules; specialty and maintenance FAQs. Fees exclude retakes, discounts, licensing and maintenance.

By Castleport Test Prep Editorial Team · Last verified October 30, 2026 (NBRC exam rules, fees and dates; cited state and employer rules; BLS wage data)

Every RRT is also recognized as a CRT. On the standard graduate route, the RRT doesn't require a different degree. What separates them is the exam standard you met. NBRC awards the credentials; PSI administers its examinations; state licensing authorities decide permission to practice.

The exams change in January 2027. TMC: last test day is December 31, 2026. Confirm the final application cutoff with NBRC before planning a late-December appointment; its published pages give different dates. New Respiratory Therapy (RT) Examination: testing starts January 4, 2027. Low cut score = CRT. High cut score = RRT. CRT-to-Registry (alternative admission routes for qualifying CRTs) ends December 31, 2026. Eligible CSE transition candidates can continue through December 31, 2027; see the route table below.

The credentials themselves aren't changing in 2027; the exams that award them are. The exam change doesn't itself change maintenance obligations: NBRC's Credential Maintenance Program is based on the credentials you hold, not the exams you took.

Which route applies to you?

Find your situation. The deadline column is the one to act on.

Your situation What to do Deadline that matters
Graduated and ready to test now Take the TMC if you meet its admission requirements. A high-cut pass gives you the CRT and the score needed for CSE eligibility; the other CSE admission requirements still apply. Confirm the application cutoff with NBRC; test by Dec 31, 2026
Unable to meet the TMC application and testing deadlines Apply for the RT Examination if you meet its admission requirements. One sitting can award the RRT directly. Applications are open now; testing starts Jan 4, 2027
Graduating in 2027 or later on the standard graduate route Take the RT Examination. Testing starts Jan 4, 2027
Passed the TMC at the high cut by Dec 31, 2026, but not the CSE yet If you meet its admission requirements and keep your eligibility record active, finish with the CSE through Dec 31, 2027. Alternatively, if eligible, switch to the RT exam and pass at the high cut. Once you apply for the RT exam, you can't apply for the CSE anymore. CSE closes Dec 31, 2027
CRT (low cut only) with a qualifying CoARC respiratory therapy associate degree or higher You can retake the TMC for a high cut until it closes, subject to the retake waiting rules, or take the RT exam in 2027. You keep your CRT even if you score below the low cut. Past TMC/CSE attempts don't count toward your RT-exam attempts. TMC closes Dec 31, 2026
CRT who qualifies for RRT exams only through CRT-to-Registry This route ends Dec 31, 2026 and does not establish admission to the RT exam. The RT exam requires a qualifying CoARC degree or the CSRT RRT route. If you may not finish the CSE in 2026, call NBRC (913-895-4900) to check your remaining eligibility before planning around a 2027 CSE date. Dec 31, 2026
Already an RRT The exam change does not make you earn the credential again. Continue the maintenance and licensing requirements that apply to you. —
Trained outside the U.S. Foreign respiratory therapy education alone does not qualify. Holders of the Canadian Society of Respiratory Therapists (CSRT) RRT credential have a separate admission route; otherwise, check the qualifying CoARC graduate route with NBRC. —

Sources: NBRC RT Examination FAQs (dates, eligibility, attempts); NBRC Resources FAQs (application cutoff and credential rules); NBRC CSE page; NBRC: CRT-to-Registry Admission Policy Expires. The CSE-switch rule comes from an NBRC transition notice posted by Indiana's Professional Licensing Agency on September 10, 2026.

Don't let a passed exam expire. NBRC's handbook, p. 10, treats a record as inactive after a year without a scheduled examination or an indication that you intend to attempt one. If it goes inactive, NBRC nullifies a passed TMC or CSE, and you reapply under whatever rules apply then. Check your record with NBRC before relying on an old result.

What the RRT adds: clinical judgment

On the standard graduate route, the RRT doesn't require more school. It shows that you met a higher examination standard.

On the TMC/CSE route, that test is the Clinical Simulation Exam: 22 patient simulation problems (20 scored) over four hours. You gather information and make decisions as a case unfolds, and the software displays the results of your choices. The CSE is not required to earn the CRT.

From 2027, NBRC folds clinical judgment into one multiple-choice exam. According to the RT Detailed Content Outline, the 160 scored questions break down like this:

  • 100 "breadth of knowledge" questions covering the same territory as the TMC: patient data, equipment and safety, and starting and changing therapy.
  • 60 "depth of clinical judgment" questions tied to specific patients. Twenty ask what to assess or how to read the findings. Forty ask what to add, change, continue or stop. Fifty involve adults and ten involve neonatal or pediatric patients; 46 are set in a hospital.

That changes things for CRT candidates too. NBRC says that from 2027, people earning the CRT must answer enough clinical-judgment questions correctly to pass overall. Under the old system, a CRT could bypass the deep clinical-judgment test by never taking the CSE. NBRC says it intends to keep both standards where they've been, not make either easier or harder.

The two cut scores are what separate CRT from RRT on the new exam. NBRC's October 2026 scoring document, Table 1 on page 3, lists 100 correct scored answers for CRT and 106 for RRT, out of 160 scored questions. These are total-exam cut scores, not separate passing scores for each content area.

Is the RRT harder to get? NBRC's own numbers

RRT requires the higher examination standard. NBRC's 2025 results provide context, but they don't predict an individual candidate's chance of passing. Here are the percentages NBRC reports for new candidates:

Exam (2025, new candidates) Pass rate
TMC at the low cut (earns CRT) 78.5%
TMC at the high cut (score needed for CSE eligibility) 68.2%
Clinical Simulation Exam (earns RRT) 63.6%

Among repeat candidates, 29.4% of repeat TMC takers reached the high cut, and 53.0% of repeat CSE takers passed.

These are per-exam pass percentages for tests given January 1 through December 31, 2025, not the share of graduates who eventually earned each credential. The new RT exam has no results yet, so don't read these as its pass rates. The sheet does not provide separate candidate counts for these new and repeat groups; the percentages cannot be converted into exact passing counts. Source: NBRC 2025 Examinations in Review, p. 2.

Does your state require the RRT?

Your state authorization, not your NBRC credential alone, is what lets you practice where a license is required. Whether CRT is accepted depends on the state, the application route, and sometimes your credential or licensing history.

California shows how the pieces fit. There, the license is called the Respiratory Care Practitioner (RCP) license, and the board states plainly that a CRT or RRT doesn't by itself authorize you to practice in California. You need the license or a valid work permit. The examination requirement generally follows the RRT route, with a pre-2015 CRT exception.

These are selected state requirements and CRT exceptions, not a complete state-by-state licensing guide. The date column distinguishes current rules from later credential or examination cutoffs.

State Relevant date Requirement and CRT exceptions
Ohio Current rule effective Sep 30, 2026 The standard examination route requires the result that qualifies for RRT. Existing Ohio licensees initially licensed on the CRT examination may continue if they meet renewal requirements and renew on time. Reciprocal licensure follows a separate route.
California Jan 1, 2015 CRT boundary Applicants who passed the CRT examination before Jan 1, 2015 may qualify for the examination exception, subject to the statutory condition concerning prior license- or job-related discipline. Other licensing requirements still apply.
Oregon Jan 1, 2018 An Oregon licensee who obtained licensure with CRT before 2018 is not required to get RRT. New applicants otherwise need an active RRT and must meet the remaining application requirements.
New Mexico Jan 1, 2018 licensing-history boundary CRT can still qualify if the applicant was licensed in New Mexico or another U.S. jurisdiction before Jan 1, 2018. CRT applicants cannot use expedited licensure. The standard route requires a current RRT.
Georgia Mar 15, 2020 CRT cutoff Active CRT issued before Mar 15, 2020 accepted; an active Certified Respiratory Therapy Technician (CRTT) credential issued before July 1, 1999 is another exception. Otherwise, the rule requires an active RRT.
Washington Licenses issued on or after Jul 1, 2022 The examination requirement includes a clinical simulation examination. An active RRT may satisfy it when earning that credential required the specified examinations. The statute distinguishes licenses issued before Jul 1, 2022.
West Virginia Current rule effective May 1, 2025 The board accepts a current CRT or RRT regardless of when it was earned. Current reinstatement rules also accept either credential, with the applicable continuing education requirements.
Missouri Law effective Aug 28, 2026; CRT earned before Jan 1, 2027 Active RRT accepted; an active CRT earned before Jan 1, 2027 also satisfies the credential requirement. Other application requirements still apply.
Indiana Exam-pass boundary: Jan 1, 2028 A board-approved respiratory care licensing or certification examination passed before 2028 remains an accepted route. For examinations completed after Dec 31, 2027, the statute requires both portions of the NBRC RRT examination.

Washington's statute and Indiana's enacted wording refer to examination components used before the one-exam transition. If you plan to use the new RT Examination for a license in either state, check the board's instructions for that examination route.

New Jersey restored CRT-examination eligibility on November 20, 2023; its statute accepts the NBRC CRT or RRT examination.

Heading to Missouri? An active CRT earned before January 1, 2027 still meets Missouri's credential requirement for a new license. The law took effect August 28, 2026; January 1, 2027 is the cutoff for when the CRT was earned. Other licensing requirements still apply.

A list isn't an application. Before you apply, confirm the current rule with your board through NBRC's state licensure agency list.

What employers do with the difference

Even where a CRT can get licensed, the job may still require the RRT. The U.S. Bureau of Labor Statistics notes that some employers require the RRT at hire or within a set time after hire.

The VA's qualification standard is a concrete example. Its regular registered respiratory therapist appointments require an active RRT and a state license. Under its temporary CRT appointment route, a licensed CRT working toward the RRT may be hired at the GS-5 level, must work under close RRT supervision, and must earn the RRT within one year or be removed from the job series. The standard also has grandfathering provisions for certain existing employees (VA RRT Qualification Standard, GS-0601, sections 5(d) and 5(g)).

An RRT credential does not automatically expand what your state authorizes you to do. Differences can show up in hiring rules, unit assignments and promotion ladders, which vary by employer, and in the NBRC specialty requirements above.

Is getting the RRT worth it?

For new graduates, aim for the RRT from the start. Some state licensing routes require it, two specialty credentials require it, and employers like the VA make it a condition of regular appointment. That's our editorial read of the sources above.

For a working CRT, the answer depends on four checks:

  1. Your state. Does the board where you work, or want to move, require the RRT for a new license? Check the table above and your board.
  2. Your job. Does the posting or your employer's policy say RRT required, RRT within a set time, or RRT preferred? Get the exact wording.
  3. Your NBRC record. Which credential do you hold, which route are you eligible for, and is your application record active?
  4. The actual payoff. Is there a written pay differential, a promotion rule, or a specialty credential you want that requires the RRT?

If none of those point to the RRT, staying a CRT can be a reasonable choice. One exception: if you'd qualify only through CRT-to-Registry, waiting past December 31, 2026 can close the door unless you later meet a different NBRC admission route.

Common questions

Which is higher, CRT or RRT?

RRT. And because NBRC recognizes every RRT as a CRT, it isn't an either-or choice. The RRT sits on top.

Do I need a bachelor's degree to become an RRT?

No. The standard route for both credentials is at least an associate degree from a CoARC-supported or accredited entry-into-practice program. Some employers prefer a bachelor's degree, but that preference is separate from NBRC's minimum.

Does a high score on the TMC make me an RRT?

Not by itself. Through 2026, a high-cut TMC pass earns the CRT and meets the score requirement for the CSE; the other admission requirements still apply. You become an RRT when you pass the CSE. On the new RT exam from 2027, a high-cut pass awards the RRT directly.

Is the CRT going away in 2027?

No. NBRC says the CRT credential is not being eliminated. Passing the new RT exam at the low cut awards the CRT. What ends is the CRT-to-Registry admission route.

Is there a deadline to get the RRT after the CRT?

Not from NBRC for graduates; it ended its three-year RRT time limit on January 1, 2021. Employers can set their own deadlines, and the CRT-to-Registry route has its own end date (December 31, 2026). The CSE also closes December 31, 2027, and the active-record rule above still applies.

How much more does an RRT earn?

The BLS does not publish a separate CRT-to-RRT pay difference. It reports one median for all respiratory therapists, $82,280 in May 2025, and doesn't split it by credential. Salary sites post separate CRT and RRT averages, but those don't show what changing one credential would add to your pay. For a real number, compare the pay scales and credential differentials of employers where you'd actually work.

I've already taken the TMC three times. Do I have to wait to take the new exam?

Those earlier attempts do not trigger the RT exam's waiting period. NBRC says earlier TMC and CSE attempts don't count toward the RT exam's limit of three attempts before 120-day waiting periods start. You still need to meet the new exam's admission requirements.

Is there a discount on NBRC exam fees?

AARC members get a one-time $40 discount on a first CSE application (and some specialty exams). It doesn't apply to the TMC.

How do employers check whether someone is a CRT or RRT?

Search NBRC's public credential directory for free, or see our guide to NBRC credential verification.

Your next step

Related Castleport guides: Respiratory therapist certification · NBRC TMC exam requirements · NBRC exam results · NBRC exam retake policy

Sources

We checked these sources on October 30, 2026. State links address the credential or examination requirement discussed here, not every step of a license application.

Castleport Test Prep is an independent exam prep publisher. We are not affiliated with, endorsed by, or approved by the National Board for Respiratory Care (NBRC). Exam and credential names identify their subjects; trademarks belong to their respective owners. This page explains published rules. Your state board and NBRC decide your eligibility.