How Hard Is the NHA Phlebotomy Exam? Pass Rates for 2023 to 2025 and What Trips Candidates Up

Most NHA CPT attempts pass, but not by a wide margin of safety: in each of the last three years NHA has reported, roughly one attempt in four failed. The pass rate is the one hard number on difficulty, and it comes straight from NHA's annual reports. The rest of the picture comes from the test plan, which shows how much of the exam sits outside the blood draw itself.

NHA CPT pass rates, 2023 to 2025

NHA publishes a yearly table for all eight of its certification exams. For the CPT:

Sources: NHA's pass-rate reports for 2023, 2024 and 2025; the 2025 report is marked "Revised: 01/09/26." Each report notes that "the scaled passing score for all examinations is 390/500."

For context, NHA's 2025 table shows 81.73% passing for the Certified Clinical Medical Assistant exam, 70.45% for the EKG Technician exam and 62.75% for the pharmacy technician exam (ExCPT). The CPT's 77.44% was the second-highest of NHA's eight exams that year, behind the CCMA.

What the NHA pass rate can and can't tell you

A few limits keep these numbers from being a forecast:

• They count exams, not people. The column is "# of Examinations Administered," so a candidate who tested twice counts twice. NHA's reports don't give a first-attempt pass rate.
• They mix every route. School-based, test center and remote exams, new graduates and experienced phlebotomists are all in one figure.
• They describe the previous version. All three years were on the test plan in use before January 7, 2026. NHA called the update's impact on content "minimal," but no pass rate for the current version had been published as of October 28, 2026.
• They say nothing about you. A 77% pass rate is not a 77% chance. Your result depends on how well you know the tasks on the test plan.

Why the NHA CPT is harder than the draw itself

Candidates who are good at venipuncture often expect the exam to be about venipuncture. NHA's test plan says otherwise.

Most of the exam isn't the needle

Routine Blood Collections is the largest domain, but it is 28 of 100 scored items. Safety and Compliance alone is 26, Patient Preparation 20, Processing 14 and Special Collections 12. In other words, 72 scored items test something other than the routine draw, and the 23 Core Knowledge statements (anatomy, hemostasis, pre-analytical errors, HIPAA, communication) can appear inside any of them.

Rules you rarely say out loud at the chair

Safety and Compliance asks about the regulations behind daily habits: OSHA and NIOSH, the bloodborne pathogens standard, exposure control plans after a needlestick or eye splash, transmission-based precautions, HIPAA, and quality control for equipment, refrigerator and freezer temperatures, and point-of-care and CLIA-waived tests. Doing these things correctly at work isn't the same as picking the rule-based answer under time pressure. That domain carries 26 of the 100 scored items, and planned NHA CPT practice includes 338 Safety and Compliance questions for that reason.

Front-desk tasks are on the test plan

Patient Preparation now includes front-desk tasks that sit outside the draw itself: confirming insurance coverage, collecting copayments and following billing protocol, creating patient accounts, entering information in the EHR, and coding systems such as ICD-10-CM. NHA's crosswalk lists the copayment, registration and EHR tasks as new with the 2026 exam, alongside communication and cultural sensitivity.

Small domains with very specific answers

Special Collections and Processing are only 26 items together, but each question tends to hinge on one detail: blood culture collection, tolerance tests, blood alcohol site preparation, drug-screen collection, chain of custody, temperature and light handling, centrifuging and aliquoting. Point-of-care testing, tolerance tests, blood alcohol site preparation and clinical research protocols are among the tasks the crosswalk lists as new.

Sequences punish near-misses

Order of draw, the steps for removing the tourniquet, tubes and needle, and the order of draw for capillary and blood culture collections all appear on the test plan. In a sequence question, knowing most of the order still gets the item wrong.

One minute per question

The exam gives 2 hours for 120 questions. Short recall items take seconds, but a scenario with a patient history and four plausible actions can take two minutes, and that time has to come from somewhere.

A Passy example: an order-of-draw question

This is an original Passy practice item, not an NHA question.

A phlebotomist will fill three tubes from one venipuncture: a light blue sodium citrate tube, a gold serum tube with clot activator and gel, and a lavender EDTA tube. No blood cultures are ordered. In what order should she fill them?

• A. Gold serum, light blue citrate, lavender EDTA
• B. Light blue citrate, gold serum, lavender EDTA
• C. Lavender EDTA, light blue citrate, gold serum
• D. Light blue citrate, lavender EDTA, gold serum

Answer: B. CLSI's public summary of its venous order of draw puts the sodium citrate tube before serum tubes, serum tubes before heparin, and EDTA after them (CLSI). The order exists to prevent additive carryover from one tube into the next. CLSI notes that plastic serum tubes with a clot activator can interfere with coagulation testing, which is why the gold tube can't come before the citrate tube (option A). EDTA comes late in the order, so options C and D, which put it ahead of the serum tube, are wrong.

Getting the answer is half the work; knowing why each option fails is what transfers to the next question, and planned NHA CPT prep explains the rule behind every answer, right or wrong.

How to tell you're ready for the NHA CPT

Signals that are more useful than the pass rate:

• You can explain every task on the test plan in a sentence, including the patient preparation and processing tasks you don't do every day
• Your timed practice holds up across all five domains, not just on average, because a weak domain shows up as Below on the score report
• You've done at least one full 2-hour timed set and finished with time to review marked items

NHA's own practice tests are built for this check: a timed baseline test and a final timed test of 100 items plus 20 pretest items each, with formative tests in between (CPT Customer FAQ). Whichever practice you use, look at results by domain, and Weak Spot drills planned for NHA CPT prep target your lowest-accuracy domain five questions at a time.

Your next step if the NHA CPT feels hard

Start with the domains you work in least, not the one you're best at. The NHA phlebotomy study plan turns the domain weights into weekly hours, and the 20 free NHA phlebotomy practice questions give you a quick first read on each domain. If you've already tested and didn't pass, the NHA CPT passing score guide explains what your domain ratings mean.