How to become a respiratory therapist

The five steps to become a respiratory therapist

A respiratory therapist needs an accredited respiratory care degree, a passing score on the NBRC credentialing exams and a state license; the steps run in this order.^{[coarc][nbrc_tmc]}

1. Finish high school with science and math. Respiratory care programs list their own prerequisites, usually biology, chemistry and algebra; check the program you plan to apply to.
2. Complete a CoARC-accredited respiratory care program. CoARC accredits the programs whose graduates may take the NBRC exams. Of 449 entry-level programs in CoARC’s 2025 report, 366 (82%) award an associate degree, 76 a bachelor’s and 7 a master’s.^[coarc]
3. Pass the NBRC Therapist Multiple-Choice (TMC) exam. Through December 31, 2026 the TMC ($190) has 160 questions and a low and a high cut score. The last application date is December 17, 2026. From January 4, 2027 it is replaced by the Respiratory Therapy Examination ($360, 185 questions, 4 hours).^[nbrc_tmc]
4. Pass the Clinical Simulation Exam (CSE) to earn the RRT. Candidates who reach the TMC high cut score by December 31, 2026 can take the Clinical Simulation Exam ($200) until December 31, 2027. After that, the RRT comes from the high cut score on the single RT exam.^[nbrc_cse]
5. Apply for your state license. Alaska became the 50th state to enact respiratory therapist licensure in June 2026. Apply to your state board with your NBRC credential; some states, such as California, require the RRT.^[aarc_lic]

NBRC exams and fees

The NBRC charges $190 for the TMC exam and $200 for the CSE for new candidates.^[nbrc_fees] Repeat attempts cost $150 for the TMC and $200 for the CSE. The new RT exam costs $360 for new applicants and $300 for repeat applicants; AARC members get a one-time $40 discount on a first attempt.

*Only for candidates who reach the TMC high cut score by Dec 31, 2026.

CRT vs RRT

Through December 31, 2026, the NBRC Therapist Multiple-Choice (TMC) exam has two cut scores: the low cut earns the CRT, and the high cut earns the CRT plus eligibility for the Clinical Simulation Exam, which leads to the RRT. From January 4, 2027 a single Respiratory Therapy Examination replaces the TMC: its low cut score earns the CRT and its high cut score earns the RRT directly.^[nbrc_tmc] BLS reports one wage for all respiratory therapists, so there is no official pay split between the two credentials; see respiratory therapist salary for the full pay table.^[oews]

Respiratory therapist license by state

Every state now has a respiratory therapist licensure law: Alaska became the 50th state in June 2026. The Respiratory Care Interstate Compact was activated in April 2026 when its seventh state enacted it, but it is not yet issuing practice privileges, so you still need a license in each state where you work.^{[aarc_lic][aarc_rcic]}

California's respiratory care practitioner license has its own rules and fees, covered on respiratory therapist salary California; Florida's $105 license and CRT or RRT levels are on respiratory therapist salary Florida. RT pay is highest in District of Columbia ($111,950 median) and lowest in Mississippi ($63,270).^[onet_rt]

How long it takes and what it costs

BLS lists an associate degree as the typical entry-level education for respiratory therapists. A public college associate degree in respiratory care is about 66 credit hours, for example the AAS at Tarrant County College in Texas, which is two years of full-time study.^{[ooh_rt][s_tcc_rt]} Program types, published tuition at public colleges and a payback calculator are on respiratory therapy school.

What respiratory therapists earn after the license

New respiratory therapists typically start near the lower percentiles: $63,660 at the 10th and $74,520 at the 25th, or $30.61 to $35.83 an hour, against a median of $82,280.^[onet_rt] Compare RT pay with the longer therapy degrees on physical therapist salary and occupational therapist salary.