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Virginia Respiratory Therapy — Requirements & Free Practice

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Licenses, application pathways and examination requirements

Each license and applicant pathway has its own requirements and exemptions. Choosing practice questions does not determine your eligibility.

Respiratory Therapist

Ordinary respiratory therapist license. Initial applicants, including applicants licensed elsewhere, satisfy the pre-September 23, 2026 education and NBRC entry-level examination requirements. The endorsement rule announced for September 23, 2026 is outside this evaluation.

Licensing authority: Virginia Board of Medicine · Application information

Reinstatement after suspension for dishonored fee payment
No examination is required for this applicant pathway.
Classification
The suspension is reported as a suspension and is not described as disciplinary action.
Prior status
The Department suspended the respiratory therapist license for a dishonored payment instrument.
Restoration
Pay the fee and statutory/regulatory penalties; §54.1-104 makes that payment the reinstatement requirement.

Official no-examination sources

Effective from 2026-09-22.

Initial licensure for applicants without prior professional practice or licensure
Therapist Multiple-Choice Examination
Applicant
No prior practice and no prior jurisdictional licensure; application items 5-7 (employment activity, jurisdictional license verifications, NPDB query) are not required.
Application
Submit the completed application, $130 fee, practice verification as applicable, supporting name-change documentation and explanations/records requested for affirmative application answers. Incomplete applications expire 180 days after submission.
Credential documentation
The April 2025 Board instructions item 2 request original documentation of a current NBRC CRT or RRT credential and graduation. These implementation requests are recorded alongside the regulation's alternative educational qualifications. Holding an RRT credential is not a separate state requirement to pass the CSE.
Education
Graduate of an accredited respiratory therapist program, or current CRT/RRT credential from NBRC or another credentialing body determined equivalent by the Board (18VAC85-40-45).
Effective date boundary
On September 22, 2026, the general licensure rule remains applicable. The new 18VAC85-40-51 endorsement rule and amendments to sections 40, 45 and 50 take effect September 23, 2026 and are not applied.
Examination equivalent
The Board may accept an equivalent examination under 18VAC85-40-50; no additional exact examination is identified by the obtained Virginia text. Other-country, other-state, discontinued, or unnamed examination evidence is an applicant condition rather than an invented requirement leaf.
New graduate practice
A graduate of an accredited respiratory therapy program may use RT-Applicant practice permission until a failing NBRC certification score or six months after graduation, whichever occurs first. This is a statutory practice exception, not a Board-issued temporary license.
Licensure for applicants previously licensed or certified in another jurisdiction
Therapist Multiple-Choice Examination
Applicant
Previously licensed or certified in another jurisdiction. Under the rule effective through September 22, 2026, document active practice (160 hours during the preceding 24 months) or 20 hours of continuing education in the preceding 24 months, and verify no disciplinary action taken or pending in that jurisdiction.
Application
Submit the completed application, $130 fee, practice verification as applicable, supporting name-change documentation and explanations/records requested for affirmative application answers. Incomplete applications expire 180 days after submission.
Credential documentation
The April 2025 Board instructions item 2 request original documentation of a current NBRC CRT or RRT credential and graduation. These implementation requests are recorded alongside the regulation's alternative educational qualifications. Holding an RRT credential is not a separate state requirement to pass the CSE.
Education
Graduate of an accredited respiratory therapist program, or current CRT/RRT credential from NBRC or another credentialing body determined equivalent by the Board (18VAC85-40-45).
Effective date boundary
On September 22, 2026, the general licensure rule remains applicable. The new 18VAC85-40-51 endorsement rule and amendments to sections 40, 45 and 50 take effect September 23, 2026 and are not applied.
Examination equivalent
The Board may accept an equivalent examination under 18VAC85-40-50; no additional exact examination is identified by the obtained Virginia text. Other-country, other-state, discontinued, or unnamed examination evidence is an applicant condition rather than an invented requirement leaf.
Practice history
Provide professional activity history since graduation, all traveler locations/dates, verifications from jurisdictions that issued full licenses and an NPDB self-query report. The April 2025 instructions require replacement of an NPDB report if the application remains incomplete three months after its receipt.
Reciprocity
The Board FAQ says there is no reciprocity and the applicant must meet education and examination requirements. Prior licensure does not remove the currently offered NBRC entry-level examination leaf; historical passing evidence and applicant-specific equivalency remain conditions.
Late active renewal within the renewal cycle using continuing education or an exemption
No examination is required for this applicant pathway.
Late status
An unrenewed license after the first day of the next month incurs the prescribed late fee; the Board directs applicants expired less than two years to its renewal system.
Practice
Do not practice while the license has lapsed.
Renewal conditions
Meet active-practice/preparedness and the approved course/service continuing-education conditions of 18VAC85-40-60 and 66, or an applicable exemption. This route does not use the unnamed specialty examination as CE evidence.

Official no-examination sources

Effective from 2026-09-22.

Reactivation using continuing practice or continuing education
No examination is required for this applicant pathway.
Board review
The Board may deny reactivation for a violation of §54.1-2915 or the chapter.
Competency
Provide continued practice in another jurisdiction while inactive, or ten hours of continuing education for each inactive year, not exceeding three years. This applicant pathway selects the non-examination competency evidence in 18VAC85-40-65(A)(1)-(2).
Fee
Pay the difference between the current inactive and active renewal fees. The 2019 form lists an older $54 amount; 18VAC85-40-65(B) supplies the controlling calculation.
Prior status
Hold an inactive Virginia respiratory therapist license.

Official no-examination sources

Effective from 2026-09-22.

Reinstatement after more than two years of lapse with practice or continuing education evidence and no Board ordered reexamination
No examination is required for this applicant pathway.
Board conditions
This route applies when the Board accepts that evidence without ordering reexamination. Under 18VAC85-40-65(C), the Board may impose additional education, experience or reexamination; the unnamed reexamination pathway is separately retained as a secondary-route note.
Competency
Select continued practice in another jurisdiction while lapsed, or ten CE hours per lapsed year, not exceeding three years, under 18VAC85-40-65(A)(1)-(2).
Documents
File the reinstatement application, pay $180, provide all required jurisdictional license verifications, an NPDB self-query, competency evidence, applicable name-change documents and explanations/records for affirmative answers. Incomplete applications expire after 180 days.
Npdb
The January 2025 reinstatement instructions require a new NPDB report if the application is not completed within six months of receipt of the report.
Prior status
The Virginia respiratory therapist license has lapsed for more than two years.

Official no-examination sources

Effective from 2026-09-22.

Biennial active renewal with continuing education or an applicable exemption
No examination is required for this applicant pathway.
Active practice
Attest to active practice (160 hours during the preceding 24 months) or present other documented evidence acceptable to the Board that the licensee is prepared to resume practice.
Continuing education
Attest to 20 hours within the biennium from approved AARC courses, AMA Category 1 respiratory-care CME, or relevant accredited college coursework. Up to two hours may come from qualifying uncompensated services at one CE hour per three volunteer service hours. The first biennial renewal is exempt; extensions or exemptions may be granted under 18VAC85-40-66(F)-(G). This route uses course/service evidence or an exemption, rather than the unnamed specialty-exam alternative.
Records
Retain supporting documentation for four years and respond to a random audit within 30 days of notification.
Schedule
Renew in each odd-numbered year during the licensee's birth month and pay the prescribed renewal fee.

Official no-examination sources

Effective from 2026-09-22.

Reinstatement after revocation when the Board grants reinstatement without further examination
No examination is required for this applicant pathway.
Application
Make a new application, pay the prescribed fee and fulfill the Board order's additional requirements.
Decision
The Board investigates and reviews the application; the applicant proves safe and competent practice by clear and convincing evidence, and reinstatement requires a three-fourths affirmative vote at the hearing.
Exam discretion
This route applies only when the Board exercises the express authority in §54.1-2408.2 to grant reinstatement without further examination. An unnamed ordered examination is represented by a separate secondary-route note.
Prior status
License revoked; normally three years must elapse before consideration, or five years for revocation under §54.1-2915(A)(19).

Official no-examination sources

Effective from 2026-09-22.

Active duty servicemember or spouse license portability
No examination is required for this applicant pathway.
Background check
The licensing authority may conduct a background check. Interstate compact license holders are governed by the compact and applicable law instead of this portability provision.
Board application
The Board portability application includes Respiratory Therapist, a $130 fee, current active unrestricted out-of-jurisdiction licensure, disclosure of all licenses, and submission to Board standards, discipline and continuing education. The form cites 50 U.S.C. §4025(a), while the actual portability provision is §4025a; the obtained codified provision controls.
Documents
Submit proof of military orders and a notarized affidavit affirming identity, complete and truthful statements, understanding of Virginia licensure and scope requirements, compliance with those requirements and good standing in all jurisdictions.
Eligibility
Hold a covered respiratory therapist license in good standing and relocate residence because of military orders; a spouse also supplies a marriage certificate. Covered-license recognition is governed by 50 U.S.C. § 4025a.

Official no-examination sources

Effective from 2026-09-22.

Reinstatement after mandatory suspension when the Board orders reinstatement without further examination
No examination is required for this applicant pathway.
Exam discretion
This route applies when the Board orders reinstatement without further examination under §54.1-2409(D). The separate pathway with an unnamed examination is retained as a secondary-route note.
Hearing
Apply to the Board; hearing is due by its next regular meeting after 60 days from receipt. The applicant may have counsel and summon witnesses; reinstatement requires a three-fourths Board vote.
Practice
No Virginia practice is permitted until reinstatement.
Prior status
Mandatory suspension under §54.1-2409 for the specified out-of-jurisdiction discipline, felony conviction or incapacity.

Official no-examination sources

Effective from 2026-09-22.

Therapist Multiple-Choice Examination

Provider
The National Board for Respiratory Care (NBRC); administered Monday through Saturday at more than 300 assessment centers through the NBRC testing agency PSI
Format
Computer-based multiple-choice examination; each scored item is linked to a content area and cognitive level (recall, application, analysis); the TMC ends December 31, 2026 and the Respiratory Therapy Examination is used from January 1, 2027
Exam questions
160 multiple-choice items: 140 scored and 20 pretest
Time limit
3 hours
Passing score
Raw score (each item worth one point) compared with two cut scores: the low cut score earns the CRT credential; the high cut score earns the CRT credential and eligibility for the Clinical Simulation Examination for candidates eligible to earn the RRT
Exam fee
$190 new applicants; $150 repeat applicants
Examination outline
  • I. PATIENT DATA (50 of 140 scored items; Recall 15, Application 27, Analysis 8) (35.71%)
    • I.A. Evaluate Data in the Patient Record (10 of 50 section items; Recall 4, Application 6, Analysis 0) — 1. Patient history, for example, history of present illness (HPI), orders, medication reconciliation, progress notes, DNR status / advance directives, social, family, and medical history; 2. Physical examination relative to the cardiopulmonary system; 3. Lines, drains, and airways, for example, chest tube, vascular lines, artificial airway; 4. Laboratory results, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 5. Blood gas analysis and / or hemoximetry (CO-oximetry) results; 6. Pulmonary function testing results, for example spirometry, lung volumes, DLCO; 7. 6-minute walk test results; 8. Imaging study results, for example, chest radiograph, CT scan, ultrasonography and / or echocardiography, PET scan, ventilation / perfusion scan; 9. Maternal and perinatal / neonatal history, for example, APGAR scores, gestational age, L / S ratio; 10. Sleep study results, for example, apnea-hypopnea index (AHI); 11. Trends in monitoring results: a. fluid balance; b. vital signs; c. intracranial pressure; d. ventilator liberation parameters; e. pulmonary mechanics; f. noninvasive, for example, pulse oximetry, capnography, transcutaneous; g. cardiac evaluation / monitoring results, for example, ECG, hemodynamic parameters; 12. Determination of a patient's pathophysiological state
    • I.B. Perform Clinical Assessment (10 of 50 section items; Recall 3, Application 6, Analysis 1) — 1. Interviewing a patient to assess a. level of consciousness and orientation, emotional state, and ability to cooperate; b. level of pain; c. shortness of breath, sputum production, and exercise tolerance; d. smoking history; e. environmental exposures; f. activities of daily living; g. learning needs, for example, literacy, preferred learning style, social / cultural; 2. Performing inspection to assess a. general appearance; b. characteristics of the airway, for example, patency, Mallampati classification, tracheal shift; c. cough, sputum amount and character; d. status of a neonate, for example, APGAR score, gestational age; e. skin integrity, for example, pressure ulcers, stoma site; 3. Palpating to assess a. pulse, rhythm, intensity; b. accessory muscle activity; c. asymmetrical chest movements, tactile fremitus, crepitus, tenderness, tactile rhonchi, and / or tracheal deviation; 4. Performing diagnostic chest percussion; 5. Auscultating to assess a. breath sounds; b. heart sounds and rhythm; c. blood pressure; 6. Reviewing a chest radiograph to assess a. quality of imaging, for example, patient positioning, penetration, lung inflation; b. presence and position of airways, lines, and drains; c. presence of foreign bodies; d. heart size and position; e. presence of, or change in, (i) cardiopulmonary abnormalities, for example, pneumothorax, consolidation, pleural effusion, pulmonary edema, pulmonary artery size; (ii) diaphragm, mediastinum, and / or trachea
    • I.C. Perform Procedures to Gather Clinical Information (12 of 50 section items; Recall 4, Application 7, Analysis 1) — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas sample collection; 6. Blood gas analysis and / or hemoximetry (CO-oximetry); 7. Oxygen titration with exercise; 8. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 9. Hemodynamic monitoring; 10. Pulmonary compliance and airways resistance; 11. Plateau pressure; 12. Auto-PEEP determination; 13. Spontaneous breathing trial (SBT); 14. Apnea monitoring; 15. Apnea test (brain death determination); 16. Overnight pulse oximetry; 17. CPAP / NPPV titration during sleep; 18. Cuff management, for example, tracheal, laryngeal; 19. Sputum induction; 20. Cardiopulmonary stress testing; 21. 6-minute walk test; 22. Spirometry outside or inside a pulmonary function laboratory; 23. DLCO inside a pulmonary function laboratory; 24. Lung volumes inside a pulmonary function laboratory; 25. Tests of respiratory muscle strength - MIP and MEP; 26. Therapeutic bronchoscopy
    • I.D. Evaluate Procedure Results (10 of 50 section items; Recall 2, Application 4, Analysis 4) — 1. 12-lead ECG; 2. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 3. Peak flow; 4. Mechanics of spontaneous ventilation linked to tidal volume, minute volume, maximal inspiratory pressure, and vital capacity; 5. Blood gas analysis and / or hemoximetry (CO-oximetry); 6. Oxygen titration with exercise; 7. Cardiopulmonary calculations, for example, P(A-a)O2, VD / VT, P/F, OI; 8. Hemodynamic monitoring; 9. Pulmonary compliance and airways resistance; 10. Plateau pressure; 11. Auto-PEEP; 12. Spontaneous breathing trial (SBT); 13. Apnea monitoring; 14. Apnea test (brain death determination); 15. Overnight pulse oximetry; 16. CPAP / NPPV titration during sleep; 17. Cuff status, for example, laryngeal, tracheal; 18. Cardiopulmonary stress testing; 19. 6-minute walk test; 20. Spirometry outside or inside a pulmonary function laboratory; 21. DLCO inside a pulmonary function laboratory; 22. Lung volumes inside a pulmonary function laboratory; 23. Tests of respiratory muscle strength - MIP and MEP
    • I.E. Recommend Diagnostic Procedures (8 of 50 section items; Recall 2, Application 4, Analysis 2) — 1. Testing for tuberculosis; 2. Laboratory tests, for example, CBC, electrolytes, coagulation studies, sputum culture and sensitivities, cardiac biomarkers; 3. Imaging studies; 4. Bronchoscopy a. diagnostic; b. therapeutic; 5. Bronchoalveolar lavage (BAL); 6. Pulmonary function testing; 7. Noninvasive monitoring, for example, pulse oximetry, capnography, transcutaneous; 8. Blood gas and/or hemoximetry (CO-oximetry); 9. ECG; 10. Exhaled gas analysis, for example, CO2, CO, FENO; 11. Hemodynamic monitoring; 12. Sleep studies; 13. Thoracentesis
  • II. TROUBLESHOOTING AND QUALITY CONTROL OF DEVICES, AND INFECTION CONTROL (20 of 140 scored items; Recall 8, Application 9, Analysis 3) (14.29%)
    • II.A. Assemble / Troubleshoot Devices (15 of 20 section items; Recall 4, Application 8, Analysis 3) — 1. Medical gas delivery interfaces, for example, mask, cannula, heated high-flow nasal cannula; 2. Long-term oxygen therapy; 3. Medical gas delivery, metering, and /or clinical analyzing devices, for example, concentrator, liquid system, flowmeter, regulator, gas cylinder, blender, air compressor, gas analyzers; 4. CPAP / NPPV with patient interfaces; 5. Humidifiers; 6. Nebulizers; 7. Metered-dose inhalers, spacers, and valved holding chambers; 8. Dry-powder inhalers (DPI); 9. Resuscitation equipment, for example, self-inflating resuscitator, flow-inflating resuscitator, AED; 10. Mechanical ventilators; 11. Intubation equipment; 12. Artificial airways; 13. Suctioning equipment, for example, regulator, canister, tubing, catheter; 14. Blood analyzers, for example, hemoximetry (CO-oximetry), point-of-care, blood gas; 15. Patient breathing circuits; 16. Hyperinflation devices; 17. Secretion clearance devices; 18. Heliox delivery device; 19. Portable spirometer; 20. Testing equipment in a pulmonary function laboratory; 21. Pleural drainage; 22. Noninvasive monitoring, for example, pulse oximeter, capnometer, transcutaneous; 23. Bronchoscopes and light sources; 24. Hemodynamic monitoring a. pressure transducers; b. catheters, for example, arterial, pulmonary artery
    • II.B. Ensure Infection Prevention (2 of 20 section items; Recall 2, Application 0, Analysis 0) — 1. Adhering to infection prevention policies and procedures, for example, Standard Precautions, donning/doffing, isolation; 2. Adhering to disinfection policies and procedures; 3. Proper handling of biohazardous materials
    • II.C. Perform Quality Control Procedures (3 of 20 section items; Recall 2, Application 1, Analysis 0) — 1. Blood analyzers; 2. Gas analyzers; 3. Pulmonary function equipment for testing a. spirometry results; b. lung volumes; c. diffusing capacity (DLCO); 4. Mechanical ventilators; 5. Noninvasive monitors
  • III. INITIATION AND MODIFICATION OF INTERVENTIONS (70 of 140 scored items; Recall 10, Application 30, Analysis 30) (50%)
    • III.A. Maintain a Patent Airway Including the Care of Artificial Airways (10 of 70 section items; Recall 3, Application 4, Analysis 3) — 1. Proper positioning of a patient; 2. Recognition of a difficult airway; 3. Establishing and managing a patient's airway a. nasopharyngeal airway; b. oropharyngeal airway; c. esophagealtracheal tubes / supraglottic airways; d. endotracheal tube; e. tracheostomy tube; f. laryngectomy tube; g. speaking valves; h. devices that assist with intubation, for example, endotracheal tube exchanger, video laryngoscopy; 4. Performing tracheostomy care; 5. Exchanging artificial airways; 6. Maintaining adequate humidification; 7. Initiating protocols to prevent ventilator-associated infections; 8. Performing extubation
    • III.B. Perform Airway Clearance and Lung Expansion Techniques (5 of 70 section items; Recall 2, Application 2, Analysis 1) — 1. Postural drainage, percussion, or vibration; 2. Suctioning, for example, nasotracheal, oropharyngeal; 3. Mechanical devices, for example, high-frequency chest wall oscillation, vibratory PEP, intrapulmonary percussive ventilation, insufflation / exsufflation; 4. Assisted cough, for example, huff, abdominal thrust; 5. Hyperinflation therapy; 6. Inspiratory muscle training
    • III.C. Support Oxygenation and Ventilation (15 of 70 section items; Recall 1, Application 5, Analysis 9) — 1. Initiating and adjusting oxygen therapy; 2. Minimizing hypoxemia, for example, patient positioning, secretion removal; 3. Initiating and adjusting mask or nasal CPAP; 4. Initiating and adjusting mechanical ventilation settings a. continuous mechanical ventilation; b. noninvasive ventilation; c. high-frequency ventilation; d. alarms; 5. Recognizing and correcting patient-ventilator dyssynchrony; 6. Utilizing ventilator graphics; 7. Performing lung recruitment maneuvers; 8. Liberating a patient from mechanical ventilation
    • III.D. Administer Medications and Specialty Gases (4 of 70 section items; Recall 1, Application 3, Analysis 0) — 1. Aerosolized preparations a. antimicrobials; b. pulmonary vasodilators; c. bronchodilators; d. mucolytics / proteolytics; e. steroids; 2. Endotracheal instillation; 3. Specialty gases, for example, heliox, inhaled NO
    • III.E. Ensure Modifications are Made to the Respiratory Care Plan (18 of 70 section items; Recall 1, Application 7, Analysis 10) — 1. Treatment termination, for example, life-threatening adverse event; 2. Recommendations a. starting treatment based on patient response; b. treatment of pneumothorax; c. adjustment of fluid balance; d. adjustment of electrolyte therapy; e. insertion or change of artificial airway; f. liberating from mechanical ventilation; g. extubation; h. discontinuing treatment based on patient response; i. consultation from a physician specialist; 3. Recommendations for changes a. patient position; b. oxygen therapy; c. humidification; d. airway clearance; e. hyperinflation; f. mechanical ventilation; 4. Recommendations for pharmacologic interventions a. bronchodilators; b. anti-inflammatory drugs; c. mucolytics and proteolytics; d. aerosolized antibiotics; e. inhaled pulmonary vasodilators; f. cardiovascular; g. antimicrobials; h. sedatives and hypnotics; i. analgesics; j. narcotic antagonists; k. benzodiazepine antagonists; l. neuromuscular blocking agents; m. diuretics; n. surfactants; o. changes to drug, dosage, administration frequency, mode, or concentration
    • III.F. Utilize Evidence-Based Practice (6 of 70 section items; Recall 0, Application 2, Analysis 4) — 1. Classification of disease severity; 2. Recommendations for changes in a therapeutic plan when indicated; 3. Application of guidelines, for example, ARDSNet, NAEPP, GOLD
    • III.G. Provide Respiratory Care in High-Risk Situations (5 of 70 section items; Recall 0, Application 2, Analysis 3) — 1. Emergency a. cardiopulmonary emergencies, excluding CPR; b. disaster management; c. medical emergency team (MET) / rapid response team; 2. Interprofessional communication; 3. Patient transport a. land / air between hospitals; b. within a hospital
    • III.H. Assist a Physician / Provider in Performing Procedures (4 of 70 section items; Recall 1, Application 3, Analysis 0) — 1. Intubation; 2. Bronchoscopy; 3. Specialized bronchoscopy, for example, endobronchial ultrasound (EBUS), navigational bronchoscopy (ENB); 4. Thoracentesis; 5. Tracheotomy; 6. Chest tube insertion; 7. Insertion of arterial or venous catheters; 8. Moderate (conscious) sedation; 9. Cardioversion; 10. Withdrawal of life support
    • III.I. Conduct Patient and Family Education (3 of 70 section items; Recall 1, Application 2, Analysis 0) — 1. Safety and infection control; 2. Home care and related equipment; 3. Lifestyle changes, for example, smoking cessation, exercise; 4. Pulmonary rehabilitation; 5. Disease / condition management, for example, asthma, COPD, CF, tracheostomy care, ventilator dependent
Examination sources