- What This Cheat Sheet Covers (and What It Doesn't)
- The Exam at a Glance: Format, Fee, Delivery
- The Four Published Domains
- Bedside Pearls Worth Memorizing
- Testing-Day Rules and Timing Math
- Testamur vs. Diplomate: Know the Difference
- Maintenance After You Pass
- Dates, Deadlines, and the Refund Discrepancy
- Sequencing Your Review by Domain
- Frequently Asked Questions
- The CCEeXAM is the National Board of Echocardiography's Examination of Special Competence in Critical Care Echocardiography: 200 questions, 180 scored.
- Five 40-question blocks run 54 minutes each, with a separate 25-minute pooled break allowance.
- Passing earns Testamur status only; Diplomate certification requires a separate application with 150 transthoracic studies.
- The January 26, 2027 sitting closes registration December 22, 2026 at 11:59 p.m. EST; the fee is USD 1,295.
What This Cheat Sheet Covers (and What It Doesn't)
This page condenses the facts that candidates most often misplace: format, fees, timing, domain names, eligibility paperwork, and the line between passing the exam and holding certification. It is a reference card, not a substitute for a structured study plan. For the full preparation roadmap, see our CCEeXAM study guide, and for a deeper look at each content area, the complete guide to all four CCEeXAM content areas.
One clarification up front. Here, CCEeXAM refers only to the Examination of Special Competence in Critical Care Echocardiography administered by the National Board of Echocardiography (NBE). It is an echocardiography credential for physicians who image critically ill patients at the bedside. It is not a general critical-care-medicine syllabus, and facts about other credentials do not transfer to it.
The Exam at a Glance: Format, Fee, Delivery
| Item | Verified Fact |
|---|---|
| Issuer | National Board of Echocardiography (NBE) |
| Official title | Examination of Special Competence in Critical Care Echocardiography |
| Total questions | 200 (180 scored, 20 unidentified unscored) |
| Structure | Five blocks of 40 questions, 54 minutes per block |
| Active answering time | 4 hours 30 minutes |
| Break allowance | 25 minutes, pooled |
| Examination fee | USD 1,295 |
| Delivery | Pearson VUE test centers or Pearson OnVUE remote proctoring |
| Passing standard | Criterion-referenced minimum knowledge standard |
What "criterion-referenced" means for you
NBE does not rank candidates against each other. You pass by demonstrating the minimum knowledge standard, and the passing score is supplied on your score report rather than advertised as a flat percentage. That means a strong cohort does not push your cut line up, and a weak one does not lower it. Our passing score breakdown covers how to interpret this.
The pass rate is not the passing score
NBE's Examinations FAQ reports an 86% pass rate for the 2026 CCEeXAM. That is the share of candidates who passed, not a threshold you must hit on the test. Confusing the two is one of the most common misreadings of this exam. For context on how to weigh that figure, read what the pass-rate data shows, and keep in mind that a high pass rate among self-selected, experienced candidates does not mean the exam is easy; see how hard the CCEeXAM really is.
The unscored items
Twenty of the 200 questions are unscored pilot items, and they are not labeled. Treat every question as if it counts. Do not spend emotional energy trying to guess which ones to ignore.
The Four Published Domains
NBE lists four exam-content headings. They are presented here as unweighted objectives, because no percentage weights have been published. Anyone quoting you a "largest domain" is guessing.
Domain 1: Functional Anatomy
The structural and physiologic foundation for everything you will interpret at the bedside.
- Standard and focused views, and which structures each window reveals
- Chamber, valve, and great-vessel anatomy as seen in limited critical-care windows
- Relationship between anatomy and hemodynamic function in shock states
- Anatomic variants and normal findings that mimic pathology in ventilated patients
Domain 2: Clinical Diagnosis and Management
Turning images into decisions. Expect case-style questions where a finding must be tied to an action.
- Undifferentiated hypotension and shock: distinguishing hypovolemic, cardiogenic, obstructive, and distributive patterns
- Acute right ventricular failure, pulmonary embolism physiology, and tamponade
- Left ventricular systolic dysfunction, regional wall motion abnormalities, and valvular emergencies
- Fluid responsiveness assessment and its limitations
- Post-cardiac-arrest and mechanical-support contexts
Domain 3: Technical Skills & Equipment Optimization
The knobs, the physics, and the artifacts that can fool you.
- Gain, depth, focus, and frequency choices and their effect on image quality
- Doppler settings, scale, and baseline errors
- Common artifacts and how to recognize them before they become false diagnoses
- Adapting acquisition when windows are poor: ventilated, dressed, or immobile patients
Domain 4: Integrated Ultrasound Imaging
Critical-care echo rarely lives alone. This domain reflects the broader bedside ultrasound picture.
- Combining cardiac findings with lung, vascular, and abdominal ultrasound data
- Building a coherent diagnostic synthesis from multiple sonographic clues
- Recognizing when an integrated finding changes the working diagnosis
The bullets above illustrate the kind of material these headings span; the official wording is the four headings themselves, which you should read against the NBE content outline directly.
Bedside Pearls Worth Memorizing
The CCEeXAM tests clinical reasoning at the bedside, so facts alone will not carry you. Still, certain patterns appear repeatedly in critical-care echo practice, and fluency with them speeds up case-style questions.
Shock patterns on a single image
- Small, hyperdynamic LV with collapsing cavity: think hypovolemia or vasodilation, then confirm with context.
- Dilated, poorly contracting LV: cardiogenic physiology; look for regional versus global dysfunction.
- Dilated RV with septal flattening: pressure or volume overload of the right heart; think pulmonary embolism, severe pulmonary hypertension, or RV infarction.
- Pericardial collection with chamber compression: tamponade is a physiologic diagnosis, not just the presence of fluid.
Questions that punish pattern-matching
Expect scenarios where the obvious pattern is wrong. A hyperdynamic ventricle can coexist with septic cardiomyopathy. A dilated IVC does not always mean high right atrial pressure in a ventilated patient. Respiratory variation signs have well-known limitations in spontaneously breathing, arrhythmic, or low-tidal-volume patients. The exam rewards candidates who know when a sign stops being reliable.
Technical traps
- Incorrect Doppler alignment underestimates velocities; know the direction of the error.
- Aliasing and baseline shifts can mimic or mask regurgitant jets.
- Poor windows in ventilated patients push you toward off-axis imaging, which distorts chamber size and wall motion assessment.
Testing-Day Rules and Timing Math
The timing arithmetic
Each 40-question block gives you 54 minutes, which works out to roughly 81 seconds per question. Case-based items with embedded images will eat more than that; simple recall items will take less. Budget accordingly and avoid sinking three minutes into one question early in a block.
How breaks actually work
Breaks are scheduled between blocks. The 25-minute allowance is pooled across the exam, and unused time in a question block adds to the break pool; it does not carry over as extra answering time for another block. In practice, finishing a block early buys you a longer rest, not more thinking time later. Use that strategically: a fast, confident finish is rewarded with recovery time.
What you can and cannot bring
- Personal reference materials are prohibited.
- An on-screen calculator is available.
- Test centers supply a laminated note board.
A note on the appointment length
NBE's live page labels the maximum appointment as five hours 20 minutes, yet the listed allowances for NDA, tutorial, breaks, question blocks, and survey sum to five hours 25 minutes. Because of that mismatch, plan around the verified active-testing figure of four hours 30 minutes and confirm your appointment logistics directly with Pearson and NBE rather than relying on the headline total.
Testamur vs. Diplomate: Know the Difference
This is the single most misunderstood point about the credential. Passing the examination establishes Testamur status. It does not automatically make you a Diplomate in Critical Care Echocardiography. Certification is a separate application with its own requirements.
| Stage | What It Requires |
|---|---|
| Sit the exam | Medical-practice documentation (license or eligible training/temporary license, or notarized ACGME program director good-standing letter for North American-trained candidates); English documents or certified translation |
| Testamur status | Passing the CCEeXAM |
| Diplomate certification | Valid Testamur status, qualifying medical licensure and medical-specialty board certification, accepted critical-care training or practice, and 150 medically necessary complete critical-care transthoracic studies with supervisor review and required logs |
Eligibility to sit the exam
Clinical case logs are not prerequisites merely to sit the examination. North American-trained candidates submit an unexpired medical license, including an eligible training or temporary license, or a signed, notarized good-standing letter from their ACGME program director. Non-North-American-trained candidates need medical licensure plus permanent-license verification or recent good-standing documentation where applicable. For the full paperwork picture, see our CCEeXAM requirements guide.
Training and practice routes to certification
- Training route: at least one year of qualifying critical-care fellowship, or 750 critical-care clinical hours in the preceding three years.
- Practice and hybrid routes: 20 echocardiography AMA Category 1 CME hours in that period.
- Fifty transesophageal studies are an optional add-on, not a baseline requirement for the written exam.
Candidates weighing whether the full pathway pays off should read our ROI analysis. The career value is real for clinicians who image critically ill patients, but this article makes no salary-premium claim, and you should be skeptical of anyone who does without a source. If compensation is your angle, our salary guide treats the topic qualitatively.
Maintenance After You Pass
New passers enter annual maintenance the following January, and the first participation year is free. The currently published annual fee is USD 85 thereafter. The program differs by status: MOTE (Maintenance of Testamur in Echocardiography) applies to Testamurs, while MOCE (Maintenance of Certification in Echocardiography) applies to Diplomates.
- Annual enrollment is required.
- You answer 48 questions per year, delivered as 12-question quarterly sets.
- You must reach an annual MDT value of at least 0.20 by December 31.
MDT is not a raw percentage score, so do not interpret 0.20 as "20% correct." MOCE adds requirements on top: qualifying medical licensure and training, clinical echo interpretation, participation in echo quality improvement, and 15 echocardiography CME credits in the preceding three years (or the permitted next-calendar-year attestation). Legacy ten-year cycles are honored where applicable, but older static-ten-year language should not be applied to new 2027 passers.
Dates, Deadlines, and the Refund Discrepancy
| Item | Detail |
|---|---|
| Upcoming administration | January 26, 2027 |
| Registration closes | December 22, 2026 at 11:59 p.m. EST |
| Exam fee | USD 1,295 |
| Partial-refund deadline | Conflicting: January 12, 2027 (live page and handbook summary) vs. January 26 (one handbook paragraph) |
Plan around the earlier refund date, January 12, 2027, and do not assume the later one without written clarification from NBE. For scheduling logistics and what to do if you miss a window, see our exam dates and deadlines guide, and for the full financial picture including maintenance, the certification cost breakdown.
Sequencing Your Review by Domain
Because NBE publishes no weights, spread effort across all four domains and adjust to your own gaps. A reasonable ordering moves from foundations to synthesis, because the later domains lean on the earlier ones.
Functional Anatomy and Technical Skills
- Rebuild view-by-view anatomy and the knobology behind each acquisition
- Drill artifacts and Doppler pitfalls early, since they underlie every later interpretation
Clinical Diagnosis and Management
- Work shock phenotypes, RV failure, tamponade, and valvular emergencies as full cases
- Practice stating finding, physiology, and next action for each image
Integrated Ultrasound Imaging and Timed Practice
- Combine cardiac, lung, and vascular findings into single diagnostic syntheses
- Simulate 40-question, 54-minute blocks to build pacing
For a fuller plan and resource selection, return to the CCEeXAM study guide. To check your readiness against realistic question style, try the CCEeXAM practice tests and use our timed practice question sets to rehearse block pacing.
Key Takeaway
Rehearse in 40-question, 54-minute blocks. The exam's timing structure, not just its content, is what separates comfortable passes from rushed ones, and finishing blocks early lengthens your break pool.
Frequently Asked Questions
The exam has 200 questions, of which 180 are scored and 20 are unidentified unscored items. They are delivered in five 40-question blocks of 54 minutes each, so treat every question as scored.
No. Passing establishes Testamur status. Diplomate certification is a separate application requiring valid Testamur status, qualifying licensure and specialty board certification, accepted critical-care training or practice, and 150 supervised transthoracic studies with required logs.
No. NBE's FAQ reports an 86% pass rate for the 2026 CCEeXAM, meaning the proportion of candidates who passed. The passing standard is criterion-referenced, and your required score is supplied on your score report.
The examination fee is USD 1,295. You can test at Pearson VUE test centers or through Pearson OnVUE remote proctoring. Registration for the January 26, 2027 administration closes December 22, 2026 at 11:59 p.m. EST.
NBE lists four domains (Functional Anatomy; Clinical Diagnosis and Management; Technical Skills & Equipment Optimization; Integrated ultrasound imaging) but publishes no percentage weights. Prepare across all four rather than assuming a heaviest area.
If you are still orienting yourself to the credential itself, our explainers on what the CCEeXAM is and the practical paths it opens, including CCEeXAM jobs, are good next reads.