The NBCOT exam is the national certification exam for occupational therapy. If you graduate from an OT program, you take the OTR exam, which has 180 items. If you graduate from an OTA program, you take the COTA exam, which has 190 items. You get four hours for either one.
Each section below gives you the short version and links to a full post when you want more detail. We checked every fee, date, and rule below on nbcot.org in November 2026, and you should confirm them there before you apply or schedule.
NBCOT exam quick facts
Figures are from nbcot.org as of November 2026. Check them again on nbcot.org before you apply.
| Detail | OTR exam | COTA exam |
|---|---|---|
| Who takes it | Graduates of ACOTE-accredited OT programs | Graduates of ACOTE-accredited OTA programs |
| Items | 180 | 190 |
| Testing time | 4 hours | 4 hours |
| Breaks | None scheduled; clock keeps running | None scheduled; clock keeps running |
| Item types | Single-response and scenario sets | Single-response and standalone six-option multi-select |
| Score scale | 300 to 600, pass at 450 | 300 to 600, pass at 450 |
| Online fee | $540 first attempt, $430 retake | $540 first attempt, $430 retake |
| ATT window | 90 days | 90 days |
| Delivered by | Pearson VUE | Pearson VUE |
| 2025 first-time new graduate pass rate | 68% | 67% |
Who gives the exam and why you need it
The National Board for Certification in Occupational Therapy (NBCOT) writes and scores the exam. Pearson VUE delivers it at its test centers. OTR stands for Occupational Therapist Registered, and COTA stands for Certified Occupational Therapy Assistant.
Passing earns you NBCOT certification. All 50 states, Washington DC, Guam, and Puerto Rico require initial NBCOT certification to regulate occupational therapy practice. Certification is not a license, though. You must also apply to your state licensing board and meet its requirements before you can practice.
To sit for the OTR exam, you need an entry-level degree from an ACOTE-accredited OT program. For the COTA exam, you need an entry-level degree from an ACOTE-accredited OTA program. Internationally educated occupational therapists go through a separate NBCOT review first, called the Occupational Therapist Eligibility Determination (OTED).
Exam format
The OTR exam has 180 items and the COTA exam has 190 items. Both exams run four hours. There are no scheduled breaks. You can step away whenever you need to, but the exam clock keeps running while you are gone, and you must stay in the building.
Both exams use single-response multiple-choice items with three or four options and one best answer. Both also use six-option multi-select items where you choose three. The difference is how those multi-select items appear.
On the OTR exam, multi-select items come in scenario sets. Each set opens with a short practice scene, followed by four related items.
On the COTA exam, each multi-select item stands on its own with its own short stem.
Each exam also includes unscored field-test items that look exactly like the scored ones. NBCOT does not say how many there are, so you should treat every item as if it counts. You can flag items, skip them, and change answers until time runs out or you submit.
To find out what four hours of these items feels like, take a full-length timed practice exam in the Typical Prep NBCOT question bank early in your prep, so you have weeks to work on your pace. For pacing math and a full breakdown of item types, read How Many Questions Are on the NBCOT Exam.
The 2024 changes
NBCOT made its last major change on January 2, 2024. On the OTR exam, scenario sets replaced the clinical simulation test (CST) items, and the exam was set at 180 items. Both exams moved to content outlines based on NBCOT's 2022 practice analyses. Testing also moved from Prometric to Pearson VUE. The COTA item types did not change.
If a prep book or question bank still teaches CSTs, it describes an exam that no longer exists. Our post Are CSTs Still on the NBCOT Exam? explains what changed and how to spot outdated material.
How scenario sets work
A scenario set starts with an opening scene that describes a client and a setting. Four items follow. Each item has six options, and you select the three best. The sets are mixed in among the single-response items, so you will not find them grouped in one block. You can flag scenario items and come back to change your answers before you submit.
For a worked example with a rationale for every option, see NBCOT Scenario Sets Explained.
Content domains and weights
Each exam follows its own content outline, and each domain carries a set share of the items. Use these weights to decide where your study hours go.
| OTR domain | Weight |
|---|---|
| Evaluation and Assessment | 23% |
| Analysis, Interpretation, and Planning | 23% |
| Select and Manage Interventions | 38% |
| Competency and Practice Management | 16% |
| COTA domain | Weight |
|---|---|
| Collaborate and Gather Information | 27% |
| Select and Implement Interventions | 55% |
| Uphold Professional Standards and Responsibilities | 18% |
Interventions carry the most weight on both exams, at 38 percent of the OTR exam and 55 percent of the COTA exam. The OTR exam also puts almost half its weight, 46 percent, on evaluation and planning.
So most of your study time should go to how you evaluate a client and what you do next. When you learn a condition, watch its lecture in the NBCOT Explained video course or read its pages in the Occupational Therapy Essentials book, then answer practice questions on it the same day while it is fresh. For a domain by domain study plan, read NBCOT OTR Exam Content Outline and Domain Weights.
Scoring and the passing score
Both exams report a scaled score from 300 to 600, and you need 450 to pass. A scaled score is not a percent correct, so you cannot turn 450 into a set number of questions.
Your result depends on your total score only. There is no separate passing score for each domain. On multi-select items, you earn credit for each correct option you choose, and NBCOT does not take points away for wrong choices. So you should always answer every item, even when you have to guess.
If you pass, NBCOT sends a congratulatory letter with your overall score. If you do not pass, your MyNBCOT account shows your overall score and feedback on how you did in each domain. Read NBCOT Passing Score and the 300 to 600 Scale Explained for the full picture.
When scores come out
NBCOT posts scores on set dates from its scoring calendar. To be included in a release, you must test at least three days before that release date. In 2026 most release dates fell on a Thursday, so a Monday exam was the last one to make that week's release.
NBCOT had not posted its 2027 calendar as of November 2026. You should check the calendar before you pick your test date. See NBCOT Score Release Dates for how it works.
Pass rates
In 2025, 68 percent of first-time new graduates passed the OTR exam, and 67 percent passed the COTA exam. NBCOT counts a candidate as a new graduate when they test within one year of graduating.
NBCOT also reports a rate for all new graduates, counting any number of attempts. In 2025 that rate was 92 percent for the OTR exam and 85 percent for the COTA exam.
For the trend over recent years, read NBCOT Pass Rate 2025. To look up a specific program, see NBCOT Pass Rate by School.
What the NBCOT exam costs
An online application costs $540 for your first attempt, and a paper application costs $595. An online retake costs $430, and a paper retake costs $485. The fees are the same for the OTR and COTA exams.
Two other fees catch people off guard. You cannot change or cancel an appointment less than 48 hours ahead. If you try to, or if you miss your appointment, you need a new authorization to test after that appointment date passes, and the reissue costs $115. A score transfer to a state board costs $35, but you get one free if you order it with your exam application.
Fees change, so confirm them on nbcot.org before you apply. Our post NBCOT Exam Cost has the full fee table.
Applying and getting your ATT
You apply online through a MyNBCOT account. NBCOT lists these steps.
Read the Certification Exam Handbook.
Create your MyNBCOT account.
Complete the exam application, answer the character review questions, and pay the fee.
Ask your school to send your final transcript, or ask about a Degree Verification Form (DVF).
Watch your application status in MyNBCOT.
A DVF lets you test before your final transcript is ready. You must have finished all degree requirements, including fieldwork, and your program director must approve it. The registrar sends the DVF within six months of your expected graduation and in the same calendar year. Your score is held until NBCOT approves your final transcript.
Transcript review can take up to 10 business days, and longer in busy months. Once NBCOT approves your application, it sends your Authorization to Test (ATT) within three business days. The ATT is good for 90 days, and you must test within the dates printed on it. If you need more time, you can ask NBCOT to reissue the ATT for another 90 days while your application is still active. You must cancel any booked appointment first.
The full walk through is in NBCOT Application Guide and How to Get Your ATT.
Scheduling and test day
The NBCOT exam has no fixed national test dates. Appointments are offered daily at Pearson VUE centers, subject to seat availability. After you receive your ATT, you book through the Pearson VUE link in MyNBCOT. You must book at least one day ahead, since same-day appointments are not offered.
If you need to change or cancel, you must do it at least 48 hours before your appointment. Otherwise you need a reissued ATT, which costs $115.
The main exception to year-round testing is the year-end pause. The last 2026 test day is December 19, and the final 2026 score release is December 22. Testing stops from December 20, 2026 through January 3, 2027, and resumes on January 4, 2027. Read NBCOT Exam Dates 2027 before you pick a date near the holidays.
Plan for an appointment of about four hours and 45 minutes. That covers check-in and an optional tutorial, which does not come out of your four hours. Our NBCOT Test Day Rules post covers ID and check-in.
Testing accommodations
NBCOT offers testing accommodations for candidates with documented disabilities. You submit the request inside your exam application and upload your documents there. A qualified healthcare professional must describe your diagnosis, how it limits you, how it affects testing, and the accommodations they recommend. Documentation should normally be from the past seven years.
The first review takes up to 10 business days, and it can take longer in peak periods. If you ask for extra time or breaks, name the amount you need. Read NBCOT Accommodations and How to Request Them before you apply.
After you pass
Once you pass, check what your state licensing board needs. If you did not order your free score transfer with your exam application, order one now, then finish your license application. Our posts on NBCOT Certification vs State Licensure and NBCOT Score Transfer explain each step.
Your first NBCOT renewal comes four calendar years after you pass. After that, you renew every three years. Each renewal cycle requires at least 36 units of professional development.
Retakes
If you do not pass, you can apply again. NBCOT sets waiting periods between attempts.
Before attempts 2, 3, and 4, you wait 30 days after your last exam.
Before attempts 5, 6, and 7, you wait 60 days.
From attempt 8 on, you wait 90 days.
You can reapply up to 30 days before you become eligible, using your existing MyNBCOT account. You normally do not need to send your transcript again. Start your new study plan with your domain feedback, since it shows where you lost the most ground. Relearn the topics in your weakest domains with the NBCOT Explained video course or the Occupational Therapy Essentials book. Then take a timed Typical Prep practice exam to see whether those scores have moved before you book your next date.
OTR vs COTA
The two exams share the same time limit, score scale, passing score, fees, and retake rules. They differ in three ways. The OTR exam has 180 items and the COTA exam has 190. Only the OTR exam has scenario sets. The content outlines differ too, with evaluation and planning making up almost half of the OTR exam and interventions making up 55 percent of the COTA exam. See OTR vs COTA Exam Compared Side by Side for the details.
How to start studying
Start with the domain weights, since they show how the items are spread across the exam. Then practice with items in the current format, which means scenario sets for the OTR exam and standalone six-option multi-select items for the COTA exam.
Take at least one full-length timed practice exam before test day. Four hours is a long time to sit and concentrate, and you want to find out how your focus holds up in the last hour before the real thing. In the Typical Prep question bank you can build a timed exam at full length or a shorter custom one for a single study session.
After each practice set, look at the questions you missed and find the detail in the stem that should have changed your answer. Read the explanation for every option, including the ones you ruled out correctly, since the wrong options often teach the next question.
NBCOT sells its own study tools, including the NBCOT Exam StudyPack and practice tests for each exam.
Prepare with Typical Prep
Typical Prep offers the Occupational Therapy Essentials book, the NBCOT Explained video course, and an NBCOT question bank with 1,900+ questions and an explanation for every answer choice. You can learn a topic in the book or video course first, then practice it in the question bank. The Complete Bundle includes all three.
Frequently asked questions
How many questions are on the NBCOT exam?
The OTR exam has 180 items and the COTA exam has 190 items. You get four hours for either exam.
What is the passing score for the NBCOT exam?
You need a scaled score of 450 on a range of 300 to 600. This is the same for the OTR and COTA exams, and it is not a percent correct.
Are CSTs still on the NBCOT exam?
No. On January 2, 2024, scenario sets replaced CSTs on the OTR exam. The COTA exam does not have scenario sets.
What is the NBCOT pass rate?
In 2025, 68 percent of first-time new graduates passed the OTR exam and 67 percent passed the COTA exam.
How much does the NBCOT exam cost?
An online application costs $540 for a first attempt and $430 for a retake. Confirm current fees on nbcot.org before you apply.
Can I take a break during the NBCOT exam?
Yes. You can take a break whenever you need one, but the four-hour clock keeps running and you must stay in the building.