CNT Online Course Overview

Successful completion of the Council's Clean Needle Technique (CNT) course is one of the requirements for certification by the National Certification Commission for Acupuncture and Herbal Medicine (NCCAOM), as well as a licensing requirement in most states.

Administered by the Council as a one-day in-person class format since 1990, the COVID-19 pandemic required suspension of the Council's in-person CNT classes, beginning in March 2020. In response, the Council approved a proposal to transition the CNT course to a fully-online format and the redevelopment team worked tirelessly to complete the initiative as quickly as possible. 

Online CNT Course Format

Part 1: Self-Paced Online Course Modules and CNT Manual Study

After registering and being approved for the course and written exam, candidates will access the CNT course content through their online portal. The online course features a series of self-paced online video lecture modules and quizzes covering about 8 hours of content which must all be completed prior to the date of the written exam. Exam preparation should also include at least 15 hours of reading and studying the CNT Manual in addition to completing the online modules. 

Part 2: Live-Proctored Online Written Exam*

Following completion of all modules, a live-proctored 60 multiple-choice question online written exam will be administered. When registering for the course, candidates will select their preferred date and time of their written exam. This is not the date of the course, as all coursework must be completed independently by the candidate prior to the exam date. CNT written exams are typically held the first or second Saturday and Sunday of each month, with two sessions available each day. Please see the "CNT Exam Schedule" page (linked below) to see what dates and times are currently being offered for the next few months. 

Part 3: Online Practical Exam*

After passing the written exam, candidates will register for and complete a 1-on-1 online practical exam** that will be administered by an experienced Council examiner. Practical exams are typically held approximately one week after the written exam dates on various days and at various times for about two weeks. The schedule may vary slightly to accommodate holidays. Candidates do not need to take their practical exams immediately after completing the written exam, however as of January 1, 2023 all coursework and exams must be completed within one year of initial CNT registration. For more information, please visit our Policies and Procedures page. 

*NOTE: The number of available exam dates for both the written and practical exams will be limited, based on proctor and examiner availability.

**Candidates registering as acupuncture assistants will be required to have a licensed acupuncturist present during their practical exam who will complete the needling portion of the exam.

Exam Scoring

Written Exam

Each scored item on the written exam is worth one point. To pass the CNT written exam, candidates must have a final score of 39 points or higher (out of 50 scored items). 

Practical Exam

A candidate must receive a minimum total score of 37 with no zeros to pass the practical exam. If a candidate receives a score of zero at any time during the practical exam (including in the set up of their travel kit), this will result in an automatic failure and the candidate will be required to retake the practical exam at another time. 

Exam Time Limits

To ensure consistency and fairness in administration, all CNT exams are subject to strict time limits:

• CNT Written Exam: 90 minutes
• CNT Practical Exam: 25 minutes (includes check-in)

Candidates are responsible for managing their time during each exam. Once the allotted time has expired, the exam session will automatically conclude.

For the written exam, any unanswered questions at the end of the time limit will be submitted as-is and scored accordingly. It is possible, though uncommon, for a candidate to achieve a passing score without completing all questions.

For the practical exam, however, all required procedures must be completed within the 25-minute limit to receive a passing score. Failure to complete the exam within the allotted time will result in an automatic failure for that attempt.

Time extensions are granted only for approved ADA accommodations received and confirmed by CCAHM prior to the scheduled exam date.

Online CNT Course and Exam Fees

2025

2026

As approved in the 2026 Council budget, beginning in January 2026, the fees for the CNT online course and exams will be changing. Exams scheduled in January 2026 and beyond will follow the fee structure below. This adjustment is necessary to cover transaction fees and reflects our dedication to maintaining the highest standards of excellence in acupuncture and herbal medicine education, certification, and safety. 

The Clean Needle Technique (CNT) Course is a nationally recognized credential required by the NCCAOM and most state licensing boards. Course and exam fees may be eligible for payment with 529 plan funds under the Freedom to Invest in Tomorrow’s Workforce Act. 

CNT Course Technical Standards 

Completion of the Clean Needle Technique (CNT) program is also dependent on essential, non-academic abilities and characteristics that require a minimum physical and cognitive capacity.  Those essential abilities and characteristics are also known as technical standards. Candidates should download and review the CNT Course Technical Standards (link below) before enrolling in the course and exams. 
Download Technical Standards (PDF)

IMPORTANT: The CNT Review Course: Acupuncture Safety course is NOT a substitute for the CNT online course. The CNT Review Course can only be used for California board and/or NCCAOM professional development/continuing education credits.

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