CSFA Pass Rate, Format & Study Guide

The Certified Surgical First Assistant (CSFA) is administered by the National Board of Surgical Technology and Surgical Assisting (NBSTSA) — the credentialing body that has been the standard-setter for surgical technology certification since 1970 (operating in its earlier years as the Liaison Council on Certification for the Surgical Technologist, LCC-ST, before its current name and structure) — and is not to be confused with the similarly abbreviated "CSA" credential from an unrelated certifying body. NBSTSA's development of a dedicated surgical-first-assistant exam began in 1991, when the Association of Surgical Technologists (AST) and a committee of what would become NBSTSA studied the feasibility of a standalone certification for the surgical first assistant role — a distinct scope of practice from surgical technology, involving direct hands-on assistance to the surgeon during the operation itself (tissue handling, hemostasis, suturing, and similar direct intraoperative assistance) rather than instrument and sterile-field management.

Surgical first assistants operate in a genuinely hands-on intraoperative role that carries direct patient-safety stakes, and hospitals and surgery centers increasingly require CSFA (or equivalent formal credentialing) as a condition of employment or hospital privileging for anyone functioning in that role, rather than treating it as an optional add-on to a surgical technologist's existing credentials. For surgical technologists advancing into first-assisting work, CSFA is frequently the clearest formal signal to a surgical department or credentialing committee that the individual has been independently validated on the specific competencies of first-assisting, which go beyond what a base Certified Surgical Technologist (CST) credential alone demonstrates.

CSFA is for surgical technologists and other qualifying candidates moving into the surgical first assistant role specifically — a distinct scope of practice from standard surgical technology work, requiring direct hands-on intraoperative assistance to the surgeon rather than sterile-field and instrument management from the periphery of the operation. It's the right credential for CST-holders (or candidates with equivalent qualifying pathways) whose career trajectory is moving toward more direct, hands-on surgical assistance.

The certifying body does not publicly publish an official pass rate for this exam. Be wary of third-party sites citing a specific number here — treat any pass-rate claim you see elsewhere for this exam as unverified.

NBSTSA's own published policy states candidates may not test more than three times during any calendar year, and are required to pay the total testing fee (processing and examination) each time — so there's no discounted retake fee, and no mandatory waiting period is specified between attempts (subject only to test-center scheduling availability).

The CSFA exam is scored on a fixed raw cut score, not a percentage or scaled 0–100 range: NBSTSA states directly that a score of 99 out of the 150 scored questions (of 175 total; the other 25 are unscored pretest items) means you've passed. That cut score comes from a periodic standard-setting study using subject-matter-expert judgment rather than a fixed percentage-correct rule, so it can shift slightly between exam versions.

The CSFA exam is administered by computer and consists of 175 multiple-choice questions — 150 scored and 25 unscored pretest items mixed in indistinguishably — completed within a 4-hour session. Because scored and pretest questions can't be told apart during the exam, every question should be answered with full effort rather than assuming any particular item doesn't count toward the final score.

The CSFA exam tests the specific competencies of the surgical-first-assistant role: intraoperative technique (tissue handling, hemostasis, wound closure, and direct assistance during the operative procedure itself), surgical anatomy as applied to first-assisting decisions in real time, and the broader perioperative knowledge (sterile technique, instrumentation, and patient safety protocols) that overlaps with — but goes meaningfully beyond — what's tested on the base surgical technologist exam. NBSTSA's official Candidate Handbook outlines the exam's content areas in detail for candidates preparing to sit.

Eligibility requires graduation from a surgical first assistant program accredited by CAAHEP (the Commission on Accreditation of Allied Health Education Programs) — this is the primary pathway, verified through an official diploma, transcript, or a signed letter from the program's director or registrar on official school letterhead. Retake candidates who are already CSFA-certified use a separate eligibility track specific to retesting rather than reapplying from scratch. Experienced surgical first assistants who don't have formal CAAHEP-accredited first-assisting education but have accumulated significant qualifying work experience may also be eligible under specific conditions NBSTSA evaluates case-by-case — candidates in this position should confirm their specific pathway directly with NBSTSA before assuming automatic eligibility from work experience alone.

The application and exam fee is $240 for AST (Association of Surgical Technologists) members and $350 for non-members, which includes a non-refundable $60 processing fee built into that total. Candidates who don't pass on a given attempt and need to retest must pay the full fee again — there's no discounted retake rate — though NBSTSA does allow up to three retest attempts per calendar year, giving reasonably frequent opportunities to try again within a given year without a long mandatory waiting period between attempts.

CSFA holders (like all NBSTSA-certified surgical technologists and first assistants certified after August 31, 1977) must stay current through one of two paths: accumulating continuing education (CE) credits within their certification cycle, or periodic re-examination. NBSTSA requires this ongoing engagement specifically because surgical technique, instrumentation, and safety protocols in the operating room continue to evolve, and a credential earned years earlier without any ongoing validation wouldn't reliably reflect current practice standards. Specific CE-hour totals and cycle lengths are detailed in NBSTSA's current recertification guidance, which candidates approaching a renewal should pull directly from nbstsa.org rather than relying on older secondhand summaries, since exact CE requirements can be updated by NBSTSA over time.

With 175 questions (only 150 scored, 25 unscored pretest items mixed in unidentifiably) over 4 hours and a 99/150 cut score, you're working with roughly 1.4 minutes per question and a ~66% raw target — tighter than it sounds once you factor in reading time on scenario-based OR questions. Because NBSTSA draws heavily on actual intraoperative technique and surgical anatomy rather than pure recall, prioritize case-based practice questions over flashcard-style review, and do at least one full 175-question timed run in the final weeks so the pacing (not the content) isn't what trips you up.

No structural changes to the CSFA exam's 175-question/4-hour format or NBSTSA's fee structure have been publicly announced as of August 2026. NBSTSA periodically updates its Candidate Handbook (the authoritative source for eligibility, fees, and content-area guidance) — candidates should confirm they're referencing the current edition directly from nbstsa.org before applying, given that fees and specific eligibility documentation requirements can shift between handbook revisions.