Confirm your eligibility route first, then study the 2025 content outline in weight order, starting with Intraoperative Procedures (68 scored items) and Anatomy and Physiology (18). Use the official reference list and NBSTSA practice exams, protect your fees by following the ATT, identification, and rescheduling rules, and check the current cut score at nbstsa.org before test day.
What the CST exam is and which version applies
The CST examination, administered solely by the National Board of Surgical Technology and Surgical Assisting (NBSTSA), tests the knowledge behind surgical technologist practice. Study from the 2025 Candidate Handbook and the content outline effective January 1, 2023.
NBSTSA is the sole decision-maker for CST certification. Exam content comes from a nationwide job analysis of tasks surgical technologists perform, and the outline is reviewed on a set schedule so it reflects current practice. That is why the outline — not a review course's topic list — should drive what you study.
The credential certifies the surgical technologist role: managing surgical instruments, maintaining the sterile field, and preparing the operating room so procedures run safely. Keep this distinct from the CSFA credential, which NBSTSA also administers for surgical first assistants. Materials aimed at the wrong role will distort how you answer role-based questions.
For version control: the current candidate handbook is the 2025, 1st Edition, and the examination content outline took effect on January 1, 2023. Both are available through NBSTSA's resource library, which is also where any newer editions will appear.
Official sources: NBSTSA CST Examination Content Outline — Content outline, effective 1/1/2023; NBSTSA CST Candidate Handbook — 2025, 1st Edition; NBSTSA official resource library — Resource library listing CST handbook, content outline, and practice test
Eligibility routes and required documents
There are three eligibility routes: current or previous CST certification, graduation from a CAAHEP- or ABHES-accredited surgical technology program, or graduation from a military training program in surgical technology.
Each route requires specific proof. Recertifying or previously certified candidates show evidence of CST certification. Program graduates submit a diploma or transcript, or a notarized and signed letter on official school letterhead from the program director or registrar stating the graduation date and degree type. Military route graduates provide a DD214 or Joint Services Transcript.
NBSTSA retains sole authority over eligibility and does not refund processing or rush fees for applicants who are found ineligible, so verify your route before paying. Once your application, documentation, and fees are approved, you receive an Authorization To Test (ATT) email containing your ATT number and instructions for scheduling with the testing agency.
- Route 1: current or previously certified CST — evidence of certification
- Route 2: graduate of a CAAHEP- or ABHES-accredited program — diploma, transcript, or notarized letter
- Route 3: military training program graduate — DD214 or Joint Services Transcript
Official sources: NBSTSA CST Candidate Handbook — 2025, 1st Edition
Format, scheduling, and what test day looks like
The exam is 175 multiple-choice questions, of which 150 are scored and 25 are unscored pretest items, delivered in four hours at PSI testing centers by appointment.
The 25 pretest items are randomly distributed throughout the exam and do not count toward your score, so you cannot identify them and should answer every question with equal care. You may take breaks whenever you wish, but the clock keeps running — no time is added back.
Testing is offered year-round at PSI centers nationwide, Monday through Saturday at set appointment times. Schedule online or by phone soon after your ATT arrives, and take the exam before the expiration date on the ATT email or you forfeit your fees. Walk-ins are not admitted.
Bring two current forms of identification, one with a photograph, and the names must match your ATT. Arrive on time: a candidate who is 15 or more minutes late is not admitted and forfeits all fees paid. You may reschedule once at no charge by contacting PSI at least 48 hours before your session, and the new date must fall within your six-month eligibility period.
Official sources: NBSTSA CST Candidate Handbook — 2025, 1st Edition
The content outline and where the questions sit
The outline has three major areas: Perioperative Care (97 scored items), Ancillary Duties (23), and Basic Science (30). Intraoperative Procedures alone carries 68 items, the largest single block.
The handbook states the outline determines how many questions from each area appear on the exam, which makes these counts your most reliable planning tool. Perioperative Care spans preoperative preparation, intraoperative procedures, and postoperative procedures. Ancillary Duties covers administrative and personnel work plus equipment sterilization and maintenance. Basic Science splits into anatomy and physiology, microbiology, and surgical pharmacology.
Within Basic Science, anatomy and physiology runs through the body systems as they relate to surgical procedures; microbiology addresses infection control, aseptic technique, wound healing, and surgical wound classification; surgical pharmacology covers anesthesia-related agents, drug types and interactions, maximum dosage awareness, and weights, measures, and conversions. The full task lists are long — download the official outline and treat it as your checklist rather than relying on any summary, including this one.
| Major area | Subarea | Scored items |
|---|---|---|
| Perioperative Care | Preoperative Preparation | 19 |
| Perioperative Care | Intraoperative Procedures | 68 |
| Perioperative Care | Postoperative Procedures | 10 |
| Ancillary Duties | Administrative and Personnel | 7 |
| Ancillary Duties | Equipment Sterilization and Maintenance | 16 |
| Basic Science | Anatomy and Physiology | 18 |
| Basic Science | Microbiology | 6 |
| Basic Science | Surgical Pharmacology | 6 |
| Total scored | 150 |
Official sources: NBSTSA CST Examination Content Outline — Content outline, effective 1/1/2023; NBSTSA CST Candidate Handbook — 2025, 1st Edition
A weight-aware study order, with a worked check
Editorial advice: because item counts drive question distribution, study Intraoperative Procedures first, then anatomy and physiology and equipment sterilization, and cross-reference the outline against the official reference list.
This ordering is study strategy, not an official requirement. Start with the subarea that carries nearly half the scored questions, then cover the mid-weight areas, and finish with the smaller pharmacology and microbiology blocks. The handbook's own study tips support this approach: familiarize yourself with every subject in the outline, cross-reference the outline with the recommended references, and complete the Examination Study Evaluation to identify your weakest areas.
NBSTSA offers online Practice Examinations that give per-question analysis and overall performance feedback, plus a mobile study app carrying the same questions. The reference list includes current editions of texts such as Alexander's Care of the Patient in Surgery, Surgical Technology: Principles and Practice, Surgical Technology for the Surgical Technologist, and Pharmacology for the Surgical Technologist — NBSTSA and its examination committee use the most recent editions when writing questions, so match editions before you buy.
Practice exercise
Using the official scored item counts: Intraoperative Procedures contains 68 items and the exam has 150 scored questions. What percentage of scored questions come from Intraoperative Procedures? Perioperative Care as a whole contains 97 scored items — what percentage is that? Round to one decimal place.
Show answer
68 ÷ 150 × 100 = 45.3%. 97 ÷ 150 × 100 = 64.7%. Intraoperative Procedures alone is about 45% of the scored exam, and Perioperative Care is nearly two thirds.
This is pure arithmetic on the counts published in the content outline, and the handbook confirms the outline determines how many questions come from each area. The 25 unscored pretest items are excluded from both calculations, so no assumption about their distribution is needed. The result justifies starting your review with intraoperative content before the smaller subareas.
Official sources: NBSTSA CST Candidate Handbook — 2025, 1st Edition; NBSTSA official resource library — Resource library listing CST handbook, content outline, and practice test
Fees, refunds, and retaking
The exam application fee is $230 for AST members and $340 for all others. The $60 application processing fee is non-refundable, and no refund is issued once an ATT has been issued.
Submit the full fee with your application by money order, check, or card, payable to NBSTSA. If you are unsuccessful, you may reapply immediately, but you are limited to three attempts per calendar year, and each attempt requires a new application and the total testing fee again. There is no waiting period before you submit a retest application.
Rescheduling has its own cost rules: you get one free reschedule with at least 48 hours' notice to PSI, but missing that window or failing to appear forfeits the total testing fee and requires a fresh application. For emergencies, NBSTSA considers variances if you submit a written statement within five business days of the missed exam, with supporting documentation reaching NBSTSA within 30 business days. Note that renewal is a separate process with its own fees, so do not confuse renewal costs with the initial exam fee.
Official sources: NBSTSA CST Candidate Handbook — 2025, 1st Edition
Exam-day checklist
Before you leave for the test center, verify your ATT, identification, arrival time, and what you may bring. A single slip on these rules can cost the whole fee.
Run through this list the day before your appointment, then again before you travel:
- Scheduled your exam and taken it before the ATT expiration date
- Two current forms of ID in hand, one with a photo, both matching the ATT name
- Arrival by your assigned reporting time — 15 or more minutes late means no admission
- No textbooks, notes, phones, or personal items; only keys and a wallet may enter the testing room
- Pencils and scratch paper provided; return the scratch paper or you will not receive a score report
- No questions about exam content during the test, and no removing materials from the room
Official sources: NBSTSA CST Candidate Handbook — 2025, 1st Edition
Official sources
Facts checked against official NBSTSA documents on September 18, 2026: