- What the CCEeXAM Actually Is
- Exam, Testamur, Diplomate: Three Different Things
- Format, Fee, and Delivery
- The Four Published Content Domains
- Who Can Sit the Exam
- Scoring and What a Pass Means
- Practice Cases That Mirror the Exam Mindset
- After You Pass: Maintenance and Career Value
- Sequencing Your Preparation Around the Domains
- Frequently Asked Questions
- The CCEeXAM is the National Board of Echocardiography's Examination of Special Competence in Critical Care Echocardiography.
- The computer-based exam has 200 questions: 180 scored, 20 unscored, in five 54-minute blocks.
- The fee is USD 1,295; the next listed administration is January 26, 2027, with registration closing December 22, 2026.
- Passing earns Testamur status, which is not the same as full Diplomate certification.
What the CCEeXAM Actually Is
The CCEeXAM is the examination administered by the National Board of Echocardiography (NBE) for physicians who use ultrasound at the bedside of critically ill patients. Its full issuer title is the Examination of Special Competence in Critical Care Echocardiography. The credential name is simply Critical Care Echocardiography, and it is the only meaning of "CCEeXAM" used on this site. If you have seen the same letters attached to unrelated credentials elsewhere, set those aside: nothing about their fees, dates, or syllabi applies here.
The exam exists because critical care echocardiography is a different skill from comprehensive cardiology echo. An intensivist or anesthesiologist is rarely asked to produce a full lab-quality study. Instead, they must answer focused questions quickly: Is the right ventricle failing? Is there a pericardial collection with tamponade physiology? Is the patient fluid responsive? Is a valve lesion acute and surgical? The CCEeXAM tests whether you can acquire, interpret, and act on images in exactly that setting.
For a broader orientation to the terminology, see our explainers on what the CCEeXAM is and what CCEeXAM stands for.
Exam, Testamur, Diplomate: Three Different Things
Candidates routinely conflate the examination with the certification. NBE separates them, and understanding the distinction early prevents expensive misunderstandings.
- The examination is the written, computer-based test you register for and sit.
- Testamur status is what you earn by passing. It documents that you demonstrated the required knowledge.
- Diplomate certification is a separate application layered on top of Testamur status, with its own documentation burden.
Importantly, those case logs are not a prerequisite for simply sitting the exam. You can take the written test first and complete the clinical documentation afterward. Training and practice routes to certification include at least one year of a qualifying critical-care fellowship, or 750 critical-care clinical hours in the preceding three years. Practice and hybrid routes also require 20 echocardiography AMA Category 1 CME hours in that period. Fifty transesophageal studies are an optional add-on rather than a baseline requirement, though the handbook's wording on this point is not perfectly uniform, so confirm the paperwork for your specific route before assuming either way.
Our pages on CCEeXAM certification and what CCEeXAM certification means go deeper on the application side.
Format, Fee, and Delivery
| Element | Detail |
|---|---|
| Issuer | National Board of Echocardiography (NBE) |
| Questions | 200 total: 180 scored plus 20 unidentified unscored items |
| Structure | Five blocks of 40 questions, 54 minutes per block |
| Active answering time | 4 hours 30 minutes |
| Break allowance | Separate 25-minute pooled break time |
| Fee | USD 1,295 |
| Delivery | Pearson VUE test centers or Pearson OnVUE remote proctoring |
| Next listed administration | January 26, 2027 |
| Registration deadline | December 22, 2026, 11:59 p.m. EST |
How the blocks and breaks interact
Each 40-question block gets its own 54-minute clock. Scheduled breaks occur between blocks, and the break time is pooled. If you finish a block early, the unused minutes are added to your break pool, not to the answering time of a later block. In practice, this means you cannot "bank" time to spend on a hard block later, so pace each block independently. Roughly 80 seconds per question is the working budget, and clip-based or image-based items will consume more of it than straightforward recall.
Rules at the testing station
Personal reference materials are not permitted. An on-screen calculator is available, and test centers provide a laminated note board. Because the 20 unscored items are not identified, treat every question as if it counts.
For scheduling specifics, see CCEeXAM exam dates and deadlines and the full cost breakdown. One refund detail deserves caution: NBE's materials give conflicting partial-refund deadlines (January 12, 2027 in the summary versus January 26 in a handbook paragraph). Until NBE clarifies, assume the earlier date applies.
The Four Published Content Domains
NBE's content outline lists four domains. Crucially, no percentage weights are published, so there is no official basis for declaring one domain the largest. Treat the list as a set of exam objectives and prepare for all four. Our complete domains guide expands each area.
Domain 1: Functional Anatomy
The structural foundation. You must connect what you see on the screen to the anatomy beneath it, from every standard window.
- Chamber, valve, and great-vessel anatomy as displayed in parasternal, apical, subcostal, and suprasternal views
- Coronary territories and how they map to regional wall segments
- Pericardial and pleural anatomy relevant to effusions
- How normal anatomy appears, so abnormal findings are recognized as deviations
Domain 2: Clinical Diagnosis and Management
The decision-making core. Questions here ask what you would conclude and do, not just what you see.
- Hemodynamic assessment in shock states, differentiating hypovolemic, cardiogenic, obstructive, and distributive patterns
- Recognition of tamponade, acute right-heart strain, severe valvular regurgitation, and ventricular dysfunction
- Fluid responsiveness and volume status reasoning
- Translating a focused echo finding into a bedside management choice
Domain 3: Technical Skills & Equipment Optimization
The craft of getting usable images from patients who are ventilated, obese, bandaged, or unable to reposition.
- Transducer selection, depth, gain, and focus adjustment
- Harmonic imaging, compression, and frame-rate trade-offs
- Recognizing and correcting artifacts
- Maneuvers for difficult acoustic windows in the ICU
Domain 4: Integrated ultrasound imaging
Critical care ultrasound rarely stops at the heart. This domain covers echocardiography in context with other bedside ultrasound.
- Combining cardiac findings with lung and vascular ultrasound
- Using IVC and venous assessment alongside cardiac data
- Building a coherent picture from multiple organ systems
- Knowing when integrated findings change the working diagnosis
Who Can Sit the Exam
The gate to the written exam is documentation of medical practice, not a case log. North American-trained candidates submit either an unexpired medical license (an eligible training or temporary license counts) or a signed, notarized good-standing letter from their ACGME program director. Candidates trained outside North America need medical licensure along with the specified permanent-license verification or recent good-standing documentation where applicable. Documents must be in English or accompanied by a certified translation.
Because the written exam and the certification application have different prerequisites, many residents and fellows sit the test during or immediately after training and finish clinical logs later. For the full checklist, read our CCEeXAM requirements guide.
Scoring and What a Pass Means
NBE uses a criterion-referenced minimum knowledge standard. You are not ranked against other candidates, and there is no curve. You either demonstrate the required level of knowledge or you do not. Your actual passing score is provided on your score report, which is why this site does not publish a fixed number.
A fair question is how hard the exam is relative to that pass rate. A high rate partly reflects that candidates tend to be well-trained physicians who prepare deliberately. It does not mean the content is easy, and it should not tempt anyone into light preparation. See how hard the CCEeXAM is for a candid assessment.
Practice Cases That Mirror the Exam Mindset
The exam rewards pattern recognition tied to physiology. Working through original scenarios like these builds the right habits. (These are illustrative teaching cases, not actual exam items.)
Case A: The hypotensive post-operative patient
A patient two days after abdominal surgery becomes hypotensive and tachycardic. The apical four-chamber view shows a small, hyperdynamic left ventricle with near-cavity obliteration in systole and a collapsing inferior vena cava. The reasoning chain: small hyperdynamic LV plus a flat IVC points toward hypovolemia or vasodilation rather than pump failure. The management question that follows is about volume and the source of loss. Contrast this with a dilated, poorly contracting LV in a similar presentation, where the same blood pressure demands a completely different response.
Case B: Sudden hypoxemia on the ventilator
A ventilated patient develops abrupt hypoxemia and hypotension. The apical view shows a dilated right ventricle with septal flattening and a D-shaped left ventricle in the parasternal short axis. Right-heart strain with acute presentation raises the question of obstructive physiology, and the follow-on reasoning concerns what additional imaging and therapy the finding demands. This is a Domain 2 pattern, but it leans on Domain 1 anatomy to interpret the septal geometry correctly.
Case C: The window you cannot get
A patient with a chest dressing and a high body mass index yields a poor parasternal window. A Domain 3 question might ask which adjustment or alternate view recovers diagnostic information, such as switching to a subcostal approach, lowering the frequency, or adjusting depth and gain. Knowing the instrument controls is as testable as knowing the physiology.
Case D: When one organ is not enough
A patient with dyspnea and hypotension has bilateral lung findings and a dilated, plethoric IVC alongside reduced LV function. The integrated reading, which combines cardiac, lung, and venous information, supports a cardiogenic picture and argues against giving more fluid. This is the Domain 4 mindset: the heart is one piece of a bedside puzzle.
Key Takeaway
Practice linking every image to a physiologic conclusion and then to an action. Exam items reward the chain image → mechanism → decision, so rehearse all three links rather than memorizing isolated views.
After You Pass: Maintenance and Career Value
Passing begins an ongoing maintenance relationship with NBE. New passers enter annual maintenance the following January. The first participation year is free, and the currently published fee is USD 85 per year thereafter. Testamurs follow the MOTE track, while Diplomates follow MOCE.
- Annual enrollment is required.
- Participants answer 48 questions a year, delivered in 12-question quarterly sets.
- An annual MDT value of at least 0.20 by December 31 is required. MDT is not a raw percentage score.
- MOCE adds requirements for qualifying 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).
Older descriptions of a static ten-year cycle should not be applied to new 2027 passers. Legacy ten-year cycles are honored only where they apply to existing credentialed individuals.
Where the credential carries weight
The people most likely to value this credential are intensivists, anesthesiologists with critical care practices, emergency physicians, and pulmonary and critical care specialists who perform bedside echo. Hospitals building point-of-care ultrasound programs, ICU leaders credentialing their staff, and fellowship programs seeking objective evidence of echo competence all treat a recognized national examination as a useful signal. The credential can strengthen privileging discussions and academic profiles. We deliberately avoid quoting salary premiums, because there is no solid published figure tying this specific credential to a pay difference; our salary guide and jobs overview discuss the realistic picture, and the ROI analysis helps you weigh the investment honestly.
Sequencing Your Preparation Around the Domains
Because NBE publishes no domain weights, a balanced plan beats a speculative one. Sequence by dependency: anatomy first, because everything else builds on it, and integration last, because it draws on everything before it. The timeline below is one reasonable ordering, not an official schedule.
Domain 1: Functional Anatomy
- Map every standard view to the structures it shows
- Link coronary territories to wall segments
Domain 2: Clinical Diagnosis and Management
- Work shock, tamponade, right-heart strain, and valvular emergencies as cases
- Practice stating the finding, the mechanism, and the action
Domain 3: Technical Skills & Equipment Optimization
- Review knobology and artifact recognition
- Rehearse fixes for difficult ICU windows
Domain 4: Integrated ultrasound imaging
- Combine cardiac, lung, and venous findings
- Run mixed-domain practice blocks timed at 54 minutes
Finish with full-length timed simulations that respect the five-block structure, so the pacing of 40 questions per 54 minutes feels routine by exam day. Our study guide expands this approach, and the cheat sheet is useful for last-pass review. NBE does not endorse any third-party preparation product, so evaluate resources on content quality. You can also test yourself on exam-style questions in our practice test to find weak domains early.
Frequently Asked Questions
It is the National Board of Echocardiography's Examination of Special Competence in Critical Care Echocardiography, a 200-question computer-based exam for physicians who perform echocardiography in critically ill patients. Passing it confers Testamur status.
No. Passing makes you a Testamur. Full Diplomate certification is a separate application that requires additional documentation, including qualifying licensure, board certification, accepted critical-care training or practice, and 150 supervised transthoracic studies with logs.
There are 200 questions in five 40-question blocks. Of these, 180 are scored and 20 are unscored, but the unscored items are not identified, so answer every question carefully.
No. Clinical case logs are not required merely to sit the written exam. Registration requires medical-practice documentation such as an unexpired license or an ACGME program director good-standing letter. Logs matter later for Diplomate certification.
NBE does not publish percentage weights, so no domain can be officially called the largest. Prepare across all four: Functional Anatomy; Clinical Diagnosis and Management; Technical Skills and Equipment Optimization; and Integrated ultrasound imaging.
For a plain-language summary of the name itself, see What Is A CCEeXAM? and our short explainers on the meaning of CCEeXAM and what CCEeXAM means. If you are planning formal skill-building before the exam, our overview of CCEeXAM training outlines options. Always confirm current dates, fees, and eligibility directly with NBE before registering, since details change between administrations.