- The 2025 national first-take CSFA pass rate is 62%, per NBSTSA data.
- You need 99 correct answers out of 150 scored questions to pass.
- Perioperative Care is 55% of the exam - the single biggest factor in pass/fail outcomes.
- 25 of the 175 questions are unscored pretest items, but you won't know which ones.
The 2025 Pass Rate Numbers
According to NBSTSA data, the national first-take pass rate for the CSFA exam in 2025 was 62%. That means roughly 4 in 10 candidates who sit for the exam on their first attempt do not clear the required score of 99 correct answers out of 150 scored questions. This isn't a "gotcha" statistic - it reflects the fact that the CSFA is a specialty credential built on top of an already rigorous surgical technology or surgical assisting background, and it tests depth, not just recall.
For context on what that 99-question threshold actually means: the exam delivers 175 total questions, but only 150 are scored. The other 25 are unscored pretest items NBSTSA uses to evaluate future exam content. You will not know which questions count and which don't, so every question has to be treated as if it's scored. This single mechanic explains a lot of candidate anxiety - and a lot of wasted time on the harder pretest items that don't even affect the outcome.
Why Perioperative Care Drives the Pass Rate
The CSFA exam is built around three content domains, and their weighting is not evenly distributed:
| Domain | Weight | Approx. Scored Questions |
|---|---|---|
| Perioperative Care | 55% | ~82-83 of 150 |
| Basic Science | 31% | ~46-47 of 150 |
| Ancillary Duties | 14% | ~21 of 150 |
Because Perioperative Care alone accounts for more than half the scored content, it is mathematically impossible to pass the CSFA exam without strong command of this domain - no amount of Basic Science or Ancillary Duties knowledge can offset weakness here. Within Perioperative Care, Intraoperative Procedures is the heaviest subcategory, covering tissue handling, hemostasis, exposure and retraction technique, wound closure, and intraoperative decision-making alongside the surgeon.
Perioperative Care (55%)
Candidates must demonstrate applied judgment across the full surgical episode, not just isolated facts.
- Preoperative patient positioning, prepping, and draping rationale
- Intraoperative tissue handling, hemostasis, and exposure techniques
- Wound closure methods and postoperative wound management
- Recognizing and responding to intraoperative complications
For a question-by-question breakdown of this domain, the dedicated guide at CSFA Domain 1: Perioperative Care (55%) - Complete Study Guide 2026 maps every subtopic to how it typically appears on the exam.
Exam Format and Why It Trips Candidates Up
The CSFA is a 4-hour, computer-based multiple-choice exam delivered at PSI testing centers. That time limit sounds generous until you do the math: 175 questions in 240 minutes gives you roughly 82 seconds per question on average, and many Perioperative Care items are scenario-based rather than simple recall, requiring you to read a clinical vignette, weigh options, and select the best next action.
Testing center rules are strict and worth internalizing before exam day: no textbooks, notes, personal study materials, or electronics are allowed in the testing room. Scratch paper is provided by the proctor and must be returned before you leave - you cannot bring in your own notes or take anything out. Candidates who haven't tested at a PSI center before sometimes lose composure over these procedural details, which is an avoidable way to burn mental energy that should go toward the exam itself.
Key Takeaway
Practice pacing yourself at roughly 80-90 seconds per question during mock exams so the 4-hour limit feels familiar rather than stressful on test day.
The multiple-choice format itself rewards a specific test-taking skill: eliminating distractors that are technically true but not the best answer for the clinical scenario presented. This is especially common in Basic Science questions, where anatomy or pharmacology facts get wrapped in a surgical context. For a deeper look at how the question style differs from other allied health exams, see Best CSFA Practice Questions 2026: What to Expect on the Exam.
Who Tends to Pass on the First Attempt
Every CSFA candidate has already completed the same prerequisite: graduation from a CAAHEP-accredited Surgical First Assistant program. So the pass rate gap isn't about who has the credential to sit for the exam - it's about how candidates used their clinical rotations and how deliberately they reviewed all three domains before test day, rather than over-focusing on whichever specialty they trained in most.
Candidates coming from a narrow surgical specialty (cardiovascular, orthopedic, general surgery, etc.) sometimes assume their rotation experience translates evenly across the exam blueprint. It doesn't. The exam draws from Perioperative Care, Ancillary Duties, and Basic Science broadly, not from any one surgical specialty, so a candidate who was excellent in the OR on orthopedic cases can still be underprepared for Ancillary Duties questions on documentation, equipment processing, or legal/ethical scope-of-practice issues.
If you're still early in deciding whether to pursue this path, Is the CSFA Certification Worth It? Complete ROI Analysis 2026 and CSFA Salary Guide 2026: Complete Earnings Analysis go further into the career-side calculus, while What Is CSFA Certification? covers the fundamentals of what the credential actually verifies.
The Real Cost of a Retake
Understanding the pass rate matters financially, not just academically. The initial exam fee is $240 for AST members and $350 for everyone else. If you don't pass, recertification by examination runs $450 for AST members or $550 for non-members - substantially more than the original attempt. That gap alone is a strong argument for treating your first sitting as the only sitting you plan for.
| Scenario | Cost |
|---|---|
| Initial exam (AST member) | $240 |
| Initial exam (non-member) | $350 |
| Recertification by exam (AST member) | $450 |
| Recertification by exam (non-member) | $550 |
| Renewal by CE credits | $45 |
For a complete breakdown of every fee associated with the credential over time, see CSFA Certification Cost 2026: Complete Pricing Breakdown. Given these numbers, most candidates are better served spending a few extra weeks preparing than gambling on a retake.
A Domain-Weighted Study Timeline
Given that Perioperative Care is 55% of the exam, your study schedule should not allocate equal time to all three domains - it should mirror the exam blueprint. Here's a framework that weights study time proportionally rather than evenly:
Perioperative Care Foundations
- Review preoperative positioning, prepping, and draping protocols
- Study intraoperative tissue handling and hemostasis techniques in depth
- Run timed practice sets focused only on Perioperative Care scenarios
Basic Science Integration
- Rebuild anatomy and physiology knowledge in a surgical-application context, not isolated fact review
- Connect pharmacology and microbiology topics to the surgical scenarios they support
- Mix Basic Science questions with Perioperative Care to reinforce cross-domain thinking
Ancillary Duties Cleanup
- Cover documentation, legal/ethical scope, and equipment handling - the smallest domain but still 14% of your score
- Don't skip this domain just because it's lightly weighted; missing easy points here is avoidable
Full-Length Timed Simulation
- Take full 175-question, 4-hour practice exams to build pacing endurance
- Review every missed question by domain to identify where your last gaps are concentrated
This structure applies a light version of spaced repetition - cycling back through Perioperative Care material even after weeks 1-2 are "done" - because it's the domain most likely to determine your pass/fail outcome. For the full domain-by-domain content map this timeline is built from, see CSFA Exam Domains 2026: Complete Guide to All 3 Content Areas, and for a step-by-step prep plan see CSFA Study Guide 2026: How to Pass on Your First Attempt.
Ancillary Duties (14%)
Often underestimated because of its size, this domain still requires deliberate review.
- Legal and ethical scope-of-practice boundaries for first assistants
- Equipment processing, sterilization verification, and instrument handling
- Documentation standards and communication protocols with the surgical team
Practicing under realistic exam conditions matters as much as content review. Running full-length timed sets on our CSFA practice test platform before test day helps you calibrate pacing against the real 4-hour limit rather than discovering your speed problems during the actual exam.
Basic Science (31%)
The second-largest domain, often where candidates lose points by studying anatomy in isolation rather than in surgical context.
- Anatomy and physiology as it relates directly to surgical approach and exposure
- Pharmacology relevant to perioperative medication administration
- Microbiology and infection control principles tied to sterile technique
You can drill this domain specifically using the dedicated resource at CSFA Domain 3: Basic Science (31%) - Complete Study Guide 2026, and the Ancillary Duties equivalent at CSFA Domain 2: Ancillary Duties (14%) - Complete Study Guide 2026.
If You Don't Pass: Recertification and Retake Mechanics
If you don't clear the 99-question threshold on your first attempt, NBSTSA's recertification-by-examination pathway is your route back, at the higher $450/$550 fee tier noted above. Once certified, ongoing renewal happens either through AST-approved continuing education credits submitted to AST along with a renewal application submitted to NBSTSA, or through recertification by examination if you let your CE cycle lapse. The $45 CE renewal fee is far cheaper than either exam path, which is another reason to stay current once you've passed rather than let certification expire.
Before you even reach exam day, make sure your fundamentals are solid. If terminology or scope questions like what the letters actually represent are still unclear, start with the basics: What Is CSFA?, CSFA Meaning, What Does CSFA Stand For?, What Is A CSFA?, and What Does CSFA Mean? all cover the credential from different angles. For the training pathway itself, CSFA Training and CSFA Certification outline what a CAAHEP-accredited program actually involves before you're eligible to test.
Frequently Asked Questions
The national first-take pass rate reported by NBSTSA for 2025 was 62%.
You need 99 correct answers out of the 150 scored questions. The exam includes 175 total questions, but 25 are unscored pretest items that don't count toward your score.
Perioperative Care, which makes up 55% of the exam, should receive the largest share of your study time since it represents more than half of all scored questions.
You can pursue recertification by examination, which costs $450 for AST members or $550 for non-members - higher than the original $240/$350 initial exam fee.
No. PSI testing centers prohibit textbooks, notes, personal study materials, and electronics. Scratch paper is provided by the proctor and must be returned before you leave.