- What Is A ASCeXAM, Exactly?
- Who Administers It and How It's Delivered
- Exam Format: Blocks, Timing, and Item Count
- The Six Content Domains
- Who Can Sit for It
- Registration, Fees, and Dates
- How Passing Is Determined
- Certification Levels: t, te, ts, c
- What Happens After You Pass
- Who Actually Takes This Exam
- Building an ASCeXAM-Specific Study Plan
- Frequently Asked Questions
- ASCeXAM is a 200-item, five-block exam administered once a year by the National Board of Echocardiography.
- Registration costs $1,295, and the 2026 exam is set for Tuesday, July 14, 2026.
- Physical Principles, Instrumentation, and Examination Principles is the largest of the six domains.
- Passing is criterion-referenced, not curved against other candidates.
What Is A ASCeXAM, Exactly?
ASCeXAM stands for the Adult echocardiography Special Competency Examination, a credentialing exam for physicians who read and interpret adult transthoracic, transesophageal, and stress echocardiograms. It is not a course, a certificate you print off a website, or a state license - it's a single-day, proctored knowledge exam administered by the National Board of Echocardiography (NBE), a physician-led not-for-profit organization founded in December 1998 and headquartered in Raleigh, NC.
Passing ASCeXAM earns you the designation of "Testamur" in adult echocardiography, a credential that many cardiology fellowship programs, hospital credentialing committees, and imaging labs treat as a baseline qualification for reading echo studies independently. If you're weighing whether the credential matters for your career, the detailed breakdown in Is the ASCeXAM Certification Worth It? Complete ROI Analysis 2026 covers the practical tradeoffs in more depth.
Who Administers It and How It's Delivered
The NBE contracts with Pearson VUE to deliver the exam at more than 230 Pearson Professional Centers across the United States and over 3,000 Pearson VUE Authorized Test Centers internationally. Candidates who prefer not to travel to a testing center can now sit for the exam remotely through Pearson OnVUE, which uses webcam-based proctoring from a private location.
Because the NBE is a physician-led nonprofit rather than a for-profit test publisher, it maintains a strict policy of not endorsing any third-party review course or study material. That means candidates have to be selective about which prep resources actually map to the current content outline (dated 1/2025) rather than assuming any branded course is officially sanctioned.
Exam Format: Blocks, Timing, and Item Count
ASCeXAM is built from 200 total items delivered in 5 blocks of 40 questions each. Every block is allotted 54 minutes, which works out to 4 hours and 30 minutes of pure exam item time. Once you add the administrative pieces, the full day can run up to 5 hours and 20 minutes:
- 25 minutes of pooled break time (only usable between blocks, never inside one)
- 5 minutes for the non-disclosure agreement (NDA)
- 15 minutes for an optional tutorial
- 10 minutes for an end-of-exam survey
A detail that trips up first-time candidates: unused time from one block does not roll over into another. If you finish a block in 40 minutes, that leftover time is gone - it doesn't extend your break or the next section. Pacing within each 54-minute, 40-question block (roughly 80 seconds per item) is a skill in itself, and it's worth rehearsing under timed conditions well before test day. For a deeper look at how this timing pressure compares to other board exams, see How Hard Is the ASCeXAM Exam? Complete Difficulty Guide 2026.
No calculators or reference materials are permitted at any point, and candidates must bring two forms of original, valid identification to be admitted.
The Six Content Domains
The NBE organizes ASCeXAM content into six domains. Knowing not just the names but the relative weight of each one is essential for allocating study time sensibly - a full breakdown of subtopics lives in ASCeXAM Exam Domains 2026: Complete Guide to All 6 Content Areas, but here's the shape of it.
Domain 1: Physical Principles, Instrumentation, Examination Principles
This is the largest and most heavily emphasized domain on the exam, spanning 17 subtopics - everything from basic ultrasound physics and Doppler instrumentation through 3D echocardiography and laboratory accreditation standards.
- Ultrasound wave behavior, attenuation, and resolution
- Doppler principles: pulsed wave, continuous wave, color flow, tissue Doppler
- Knobology, artifact recognition, and image optimization
- 3D echo acquisition and rendering
- Lab accreditation and quality assurance standards
Domain 2: Valvular Heart Disease
Covers stenotic and regurgitant lesions across all four valves, prosthetic valve evaluation, and the quantitative criteria used to grade severity.
- Continuity equation and pressure half-time calculations
- Prosthetic valve dysfunction patterns
- Grading criteria for mitral, aortic, tricuspid, and pulmonic disease
Domain 3: Chamber Size and Function
Focuses on quantifying left and right ventricular size and function, diastolic function assessment, and atrial measurements.
- Ejection fraction methods (Simpson's biplane, visual estimation)
- Diastolic function grading algorithms
- Right ventricular function metrics (TAPSE, S')
Domain 4: Congenital Heart Disease
Tests recognition of adult congenital lesions - the ones cardiologists actually encounter in adult imaging labs rather than pediatric echo.
- Atrial and ventricular septal defects
- Bicuspid aortic valve and associated aortopathy
- Shunt physiology and Qp:Qs assessment
Domain 5: Cardiac Masses, Pericardial Disease, Contrast and New Applications
Covers thrombus and tumor differentiation, pericardial effusion/tamponade physiology, and the growing role of contrast agents and strain imaging.
- Distinguishing thrombus, myxoma, and vegetation
- Tamponade vs. constriction hemodynamics
- Contrast-enhanced LV opacification and strain echocardiography
Domain 6: Miscellaneous Topics (Role of Echo)
Addresses the clinical decision-making context for ordering and interpreting echo - appropriate use criteria, comparative imaging, and echo's role alongside other modalities.
- Appropriate use criteria for common clinical scenarios
- Echo versus CT/MRI/nuclear imaging tradeoffs
Who Can Sit for It
ASCeXAM eligibility is built around proof that you're licensed or on track to practice medicine - MD, DO, or MBBS. The exact documentation required depends on where you trained:
- North American-trained physicians submit either a valid, unexpired medical license or a notarized Letter of Good Standing signed by their ACGME-accredited program director.
- Non-North American-trained physicians submit a valid medical license plus, if that license has no expiration date, a Medical Council letter or certificate of good standing dated within the past 12 months.
All documents must be submitted in English or accompanied by a certified translation, paid for by the candidate. The full eligibility checklist, including edge cases for residents and fellows, is laid out in ASCeXAM Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Registration, Fees, and Dates
Registration for ASCeXAM runs $1,295. If you need to cancel, the NBE refunds the fee paid minus a $200 cancellation charge - and importantly, deferments are no longer offered, so a missed exam date generally means starting the registration process over.
Because there's only one testing date per year, missing the registration window means waiting a full year for the next opportunity. A detailed timeline of deadlines, ID requirements, and what to do if your documentation is incomplete is in ASCeXAM Exam Dates 2026: Testing Windows, Deadlines & Scheduling. For a complete cost picture including MOTE fees and opportunity costs, see ASCeXAM Certification Cost 2026: Complete Pricing Breakdown.
How Passing Is Determined
ASCeXAM uses criterion-referenced scoring, which means your result is compared against a fixed minimum knowledge standard set by the NBE - not against how other candidates in your testing cycle performed. There is no curve and no fixed quota of passers.
Your score report shows the minimum score required to pass alongside your performance in each of the six main content areas, so even a passing score comes with a domain-by-domain breakdown that's useful for anyone pursuing additional certification levels later. If you want the exact mechanics of how the passing standard is set and what "criterion-referenced" means in practice, ASCeXAM Passing Score 2026: Exactly What You Need to Pass walks through it. Historical performance trends are covered separately in ASCeXAM Pass Rate 2026: What the Data Shows.
Certification Levels: t, te, ts, c
ASCeXAM certification isn't one-size-fits-all. The NBE offers four levels depending on which imaging modalities you want your credential to cover:
| Level | Code | Covers |
|---|---|---|
| Transthoracic | t | Standard TTE interpretation only |
| Transthoracic + Transesophageal | te | TTE plus TEE competency |
| Transthoracic + Stress | ts | TTE plus stress echocardiography |
| Comprehensive | c | TTE, TEE, and stress echo combined |
The underlying exam content and domains are the same regardless of which level you're pursuing - the level designation reflects the scope of practice you're attesting to, based on your training and case log requirements, not a different test.
What Happens After You Pass
Passing ASCeXAM isn't the finish line. Testamurs must enroll in Maintenance of Testamur in Echocardiography (MOTE) the January following their pass. MOTE is free for the first year, then costs $85 annually, with requirements due every December 31 to stay in good standing.
It's also worth knowing that standalone recertification exams were discontinued starting in July 2024 and replaced entirely by the ongoing MOTE/MOCE maintenance pathway - so there's no separate "recert exam" to plan for down the road the way there used to be. ABIM board-certified physicians who pass ASCeXAM can additionally claim 20 ABIM MOC points, which is a useful bonus if you're juggling multiple maintenance-of-certification obligations.
Key Takeaway
Budget for MOTE as part of your total cost of certification, not just the $1,295 registration fee - it's a recurring $85/year commitment after the first free year.
Who Actually Takes This Exam
ASCeXAM candidates are overwhelmingly cardiology fellows finishing echo-focused training, general cardiologists adding formal echo credentialing to their practice, and physicians in imaging-heavy subspecialties who need Testamur status for hospital privileging or lab accreditation purposes. Many academic and community hospital echo labs use ASCeXAM Testamur status as part of their credentialing checklist for physicians who want to independently interpret studies.
If you're evaluating how this credential plays into hiring and compensation, ASCeXAM Jobs and ASCeXAM Salary Guide 2026: Complete Earnings Analysis both look at how the credential shows up in job postings and offer discussions.
Building an ASCeXAM-Specific Study Plan
Generic study advice - flashcards, spaced repetition, timed blocks - only works if it's applied against the actual weight of ASCeXAM's domains. Because Domain 1 (Physical Principles, Instrumentation, Examination Principles) carries the most subtopics and the heaviest emphasis, it deserves the earliest and longest stretch of dedicated review, not an afterthought squeezed in during the final week.
Physical Principles & Instrumentation
- Work through ultrasound physics, Doppler modes, and knobology systematically since this domain spans 17 subtopics
- Drill artifact recognition with image-based practice questions
Valvular Disease & Chamber Quantification
- Memorize continuity equation variants and severity grading thresholds
- Practice EF and diastolic function algorithms until they're automatic
Congenital, Masses, and Miscellaneous
- Focus on adult congenital lesions most likely to appear in general imaging labs
- Review appropriate use criteria scenarios for Domain 6
Timed Block Simulation
- Practice full 40-question, 54-minute blocks to build pacing instincts
- Simulate the pooled 25-minute break structure so test-day logistics aren't a surprise
For a structured, week-by-week plan with more granular milestones, ASCeXAM Study Guide 2026: How to Pass on Your First Attempt expands on this framework, and the ASCeXAM Cheat Sheet 2026: One-Page Review of Must-Know Facts is useful for last-minute review of formulas and grading criteria. You can also sharpen pacing and question familiarity using timed practice questions on the main practice test site before test day.
Frequently Asked Questions
It's a physician credentialing exam in adult echocardiography, administered once a year by the National Board of Echocardiography, consisting of 200 questions across six content domains.
Only once - the exam is offered on a single day per year. The current cycle's date is Tuesday, July 14, 2026, with registration closing May 7, 2026.
No. ASCeXAM is the initial certifying exam. Standalone recertification exams were discontinued in July 2024 and replaced by the MOTE/MOCE maintenance pathway.
You'll be refunded the fee paid minus a $200 cancellation charge. Deferments to a future cycle are no longer offered, so cancellation means re-registering from scratch later.
Physical Principles, Instrumentation, and Examination Principles, since it's the largest domain with 17 subtopics and the heaviest emphasis on the exam.
For a broader orientation to the credential before diving into domain-specific prep, the companion pieces What Is ASCeXAM? and ASCeXAM Certification cover related angles, and you can begin building exam-day familiarity anytime with practice questions on the main practice test site.