Independent salary research. Not affiliated with BLS, NBRC, AARC, or any employer. Figures are estimates based on BLS OES May 2024 data.

RT Credentials: Salary Premium for RRT, NPS, ACCS, RPFT and SDS (2026)

The RRT credential adds $5,400/yr over CRT. Specialty credentials add another $2,000-$5,500/yr each. Every NBRC credential pays back its exam fee within the first month of higher wages.

5 credentials comparedRRT premium: ~$5,400/yrNBRC 5-year renewal cycle

The NBRC Credential Ladder

Graduate
CoARC-accredited degree
CRT
TMC low-cut score
RRT
TMC high-cut + CSE
NPS / ACCS
RPFT / SDS

Specialty credentials (NPS, ACCS, RPFT, SDS) require the RRT as a prerequisite. The CPFT is available at the CRT level and is a stepping stone to RPFT.

Full Credential ROI Comparison

All NBRC exam fees are current as of 2026. Annual premium estimates based on PayScale, Salary.com, and AMN Healthcare compensation surveys.

CredentialAnnual PremiumVerdict
RRTRegistered Respiratory Therapist+$5,000-$8,000/yrEssential
NPSNeonatal/Pediatric Specialist+$3,000-$5,000/yrEssential for NICU
ACCSAdult Critical Care Specialist+$3,500-$5,500/yrHighly recommended for ICU
RPFTRegistered Pulmonary Function Technologist+$2,500-$4,000/yrWorth it for PFT track
SDSSleep Disorders Specialist+$2,000-$3,500/yrWorth it for sleep track
CPFTCertified Pulmonary Function Technologist+$1,000-$2,500/yrStepping stone to RPFT

Credential Deep Dives

RRT - Registered Respiratory Therapist

Issued by NBRC | 5-year cycle
+$5,000-$8,000/yr
CRT median: $71,855 | RRT median: $77,271

The RRT is the most impactful credential in respiratory therapy. Most hospitals now require it for all new clinical hires. The upgrade from CRT to RRT adds approximately $5,400/yr (PayScale: $77,271 RRT vs $71,855 CRT medians). The investment of $390 in exam fees pays back within the first month of higher wages.

Prerequisite
CRT or high-cut TMC pass
Exam Cost
$190 (TMC) + $200 (CSE)
Exam Format
TMC (160 MCQ) + CSE (clinical simulation)

NPS - Neonatal/Pediatric Specialist

Issued by NBRC | 5-year cycle
+$3,000-$5,000/yr

The NPS is required or expected within 1-2 years of hire at most Level III and Level IV NICUs. It validates advanced competency in neonatal ventilator management, surfactant administration, high-frequency oscillatory ventilation, and ECMO support. NPS-credentialed RTs earn $3,000-$5,000/yr more than RRT-only peers in NICU settings.

Prerequisite
RRT + 1-2 years neonatal/pediatric clinical experience
Exam Cost
$300 exam fee
Exam Format
MCQ + clinical simulation
See salary guide for NICU setting

ACCS - Adult Critical Care Specialist

Issued by NBRC | 5-year cycle
+$3,500-$5,500/yr

The ACCS validates advanced competency in adult mechanical ventilation, hemodynamic monitoring, arterial line management, and rapid response team participation. Increasingly required for ICU charge RT and ECMO specialist roles. Adds $3,500-$5,500/yr and opens doors to flight RT and critical care transport positions.

Prerequisite
RRT + 1-2 years adult critical care experience
Exam Cost
$300 exam fee
Exam Format
MCQ + clinical simulation
See salary guide for ICU setting

RPFT - Registered Pulmonary Function Technologist

Issued by NBRC | 5-year cycle
+$2,500-$4,000/yr

The RPFT is the highest-level PFT credential, covering spirometry, lung volumes, diffusing capacity, bronchoprovocation, cardiopulmonary exercise testing, and methacholine challenge. The outpatient pulmonary setting offers daytime hours, lower acuity, and a strong procedural focus. Outpatient RTs with RPFT are rare, making them highly sought after.

Prerequisite
RRT + CPFT credential or equivalent experience
Exam Cost
$300 exam fee
Exam Format
MCQ examination
See salary guide for Outpatient pulmonary clinics setting

SDS - Sleep Disorders Specialist

Issued by NBRC | 5-year cycle
+$2,000-$3,500/yr

The SDS validates competency in polysomnography setup and scoring, titration studies (CPAP, APAP, bilevel), and home sleep testing. It is an alternative to the RPSGT (Board of Registered Polysomnographic Technologists) and is accepted by most sleep labs. Sleep lab work offers predictable night-shift hours, lower acuity than ICU/NICU, and high autonomy.

Prerequisite
RRT + sleep lab experience
Exam Cost
$300 exam fee
Exam Format
MCQ examination
See salary guide for Sleep labs setting

CPFT - Certified Pulmonary Function Technologist

Issued by NBRC | 5-year cycle
+$1,000-$2,500/yr

The CPFT is the entry-level pulmonary function credential. It covers basic spirometry, lung volume measurements, and diffusing capacity. The CPFT is a prerequisite for or stepping stone to the RPFT. On its own, the CPFT adds a modest $1,000-$2,500/yr premium, primarily valued in outpatient and clinic settings.

Prerequisite
CRT credential or eligible to sit for NBRC
Exam Cost
$300 exam fee
Exam Format
MCQ examination

Frequently Asked Questions

Which credential should I get first after CRT?
Get the RRT first, without exception. The RRT is required or strongly preferred for new hires at most hospitals, adds $5,400/yr on average, and is a prerequisite for all specialty credentials. Once you have the RRT and 1-2 years of clinical experience, choose your specialty credential based on your setting: ACCS for ICU, NPS for NICU, RPFT for PFT lab, SDS for sleep lab.
Can I take specialty exams before earning the RRT?
No. The NBRC requires the RRT as a prerequisite for all specialty credentials (NPS, ACCS, RPFT, SDS). You must pass the TMC at the high-cut score and the CSE to earn the RRT before applying for any specialty exam.
How often do NBRC credentials need to be renewed?
All NBRC credentials operate on a 5-year renewal cycle. Renewal is typically accomplished through continuing competency credits earned through continuing education, clinical assessments, or re-examination. Failing to maintain credits results in credential lapse.
What is the RPFT and who should get it?
The RPFT (Registered Pulmonary Function Technologist) validates competency in spirometry, lung volumes, diffusing capacity, bronchoprovocation, and cardiopulmonary exercise testing. Best suited for RTs in outpatient pulmonary clinics or hospital PFT labs. Adds $2,500-$4,000/yr and is a strong differentiator since RPFT-credentialed RTs are rare.
What is the SDS credential and who should get it?
The SDS (Sleep Disorders Specialist) validates competency in polysomnography, CPAP/BiPAP titration, and sleep diagnostics. It is an NBRC alternative to the RPSGT and is accepted by most sleep labs. SDS adds $2,000-$3,500/yr and is best for RTs who already hold a respiratory therapy degree and want to specialise in sleep medicine.
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