CCEeXAM Passing Score 2026: Exactly What You Need to Pass

What "Passing Score" Means on the CCEeXAM

Candidates searching for a single number to aim for are usually disappointed by the first honest answer: the National Board of Echocardiography (NBE) does not publish a fixed percentage you must hit on the Examination of Special Competence in Critical Care Echocardiography (CCEeXAM). Instead, the exam is built around a criterion-referenced minimum knowledge standard. The question being answered is not "how did you do compared with everyone else this year?" but "do you demonstrate the minimum knowledge expected of a clinician competent in critical care echocardiography?"

That distinction matters for how you prepare. On a norm-referenced exam, your result depends partly on the strength of the candidate pool. On a criterion-referenced exam, a strong cohort does not raise the bar for you, and a weak cohort does not lower it. Your job is to clear a defined standard of competence, and the passing score itself is supplied on your score report after you test.

The 86% Figure: Pass Rate, Not a Cut Score

One of the most common misreadings in forums and study groups involves the number 86. NBE's Examinations Frequently Asked Questions reports an 86% pass rate for the 2026 CCEeXAM. That is the proportion of candidates who passed, not the percentage of questions you must answer correctly. These are completely different quantities, and conflating them leads candidates to believe they need to answer 86% of items correctly, which is not what NBE states.

A high pass rate also should not breed complacency. Candidates who sit this exam are typically already working in critical care or have completed relevant training, so the group is self-selected. For more on interpreting that statistic, read our breakdown of the CCEeXAM pass rate and what the data shows.

How the 200-Question Exam Is Built

Understanding the structure helps you pace yourself and removes surprises on exam day. The CCEeXAM is a computer-based examination delivered through Pearson Professional Assessments, either at Pearson VUE test centers or via Pearson OnVUE remote proctoring.

Each block is timed independently at 54 minutes for 40 questions, which works out to roughly 81 seconds per question. Image-based items, such as interpreting a clip of a hyperdynamic left ventricle or a dilated right heart, naturally consume more time than recall items, so you will want to bank time on faster questions.

Breaks and time banking

Scheduled breaks occur between blocks, drawing on a separate pooled allowance of 25 minutes. An important rule: unused time inside a question block increases the break pool, not another block's answering time. Finishing a block early therefore buys you rest, not extra minutes on a harder later block. Do not rush a block expecting to reclaim that time on block four.

On exam day, no personal reference materials are permitted. An on-screen calculator is available, and test centers supply a laminated note board for working through calculations and hemodynamic reasoning.

180 Scored Items, 20 Unscored Items

Of the 200 questions, 20 are unscored items that NBE does not identify. These are typically included to gather performance data on questions for future use. Because you cannot tell which items are unscored, the correct strategy is simple: treat every question as if it counts.

• Do not spend extra time trying to "guess" which questions are experimental.
• Do not let one baffling image-based item rattle you; it may be unscored.
• Do not interpret an unusually difficult stretch as a sign you are failing.

Only the 180 scored items contribute to the minimum-knowledge-standard result, and NBE reports the passing score on your score report rather than publishing a percentage beforehand.

Where Your Points Come From: The Four Domains

The CCEeXAM Content Outline (dated January 2025, and reproduced in the 2027 CCEeXAM Handbook) organizes the exam into four content areas. NBE lists these as exam-content headings; no percentage weights are published, so you should not assume any domain is "the biggest" or budget study time against invented weightings. Treat all four as examinable and prepare accordingly. For a fuller walkthrough, see our complete guide to all four CCEeXAM content areas.

Because the outline gives headings without weights, a balanced approach is safest. Our CCEeXAM study guide walks through how to organize preparation around these four headings.

Reading Your Score Report and What Passing Earns

After the exam, your score report supplies the passing score and your result against the minimum knowledge standard. Passing the CCEeXAM establishes Testamur status. This is an important and frequently misunderstood point: passing the written examination does not automatically make you a Diplomate of the National Board of Echocardiography in critical care echocardiography.

The certification pathway includes training or practice routes: at least one year of qualifying critical-care fellowship or 750 critical-care clinical hours in the preceding three years, with practice and hybrid routes also requiring 20 echocardiography AMA Category 1 CME hours in that period. Fifty transesophageal studies are an optional add-on, not a prerequisite for the written exam. Because the certification handbook's optional-TEE headings coexist with practice-documentation wording that lists both transthoracic and transesophageal counts, confirm the paperwork for your specific route directly with NBE rather than assuming a universal rule. For eligibility detail, see our guide to CCEeXAM requirements.

Clinical Scenarios That Test the Standard

The minimum knowledge standard is easiest to understand through the kinds of bedside reasoning the exam rewards. The following original scenarios illustrate how the four domains show up in practice. They are teaching illustrations, not actual exam items.

Notice that none of these can be answered by memorizing a number. They require pattern recognition and reasoning, which is exactly what a criterion-referenced competence standard is designed to measure.

Fee, Deadlines, and Eligibility Mechanics

Sitting for the exam requires planning around registration windows and documentation. The following details come from NBE's published CCEeXAM information.

Eligibility rests on medical-practice documentation. 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 require medical licensure and the specified permanent-license verification or recent good-standing documentation when applicable.

A Domain-Ordered Preparation Sequence

Because the standard is competence-based rather than rank-based, preparation should aim at breadth with depth in image interpretation. NBE does not endorse any third-party preparation products, so evaluate resources against the official content outline. Here is one way to sequence the four domains across a preparation window, with the reasoning for the order.

Anatomy and technical skills come first because misreading an image invalidates everything built on it. Timed block practice comes last so you rehearse the real 54-minute pacing once content knowledge is solid. Our CCEeXAM practice test is a useful way to rehearse timed blocks, and our CCEeXAM cheat sheet offers a quick final review.

After You Pass: Maintenance and Career Value

Passing does not end your obligations. New passers enter annual maintenance the following January. Testamurs participate in MOTE (Maintenance of Testamur in Echocardiography), while Diplomates participate in MOCE (Maintenance of Certification in Echocardiography). The first participation year is free, with the currently published annual fee at USD 85 thereafter.

• Annual enrollment is required.
• Participants answer 48 questions per year, delivered in 12-question quarterly sets.
• An annual MDT value of at least 0.20 must be reached by December 31. MDT is not a raw percentage passing score, so do not read 0.20 as 20%.
• MOCE adds requirements: 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. Always check the current NBE maintenance pages for your situation.

Career value without inflated claims

The practical value of the credential is demonstrable competence in a skill that intensivists, anesthesiologists, emergency physicians, and other critical care clinicians use at the bedside. Documented competence can support credentialing conversations, quality programs, and teaching roles in ICUs that rely on point-of-care and advanced echocardiography. Be skeptical of any claim of a guaranteed salary premium; no verified figure is cited here. To weigh the investment honestly, read our analyses on whether the certification is worth it, the salary guide, and CCEeXAM-related jobs.

Frequently Asked Questions

For a broader introduction to the credential, start with what CCEeXAM is and our overview of CCEeXAM certification.