Surgical Technologist Certification & State Requirements (2026)

A growing number of states now require surgical technologists to hold national certification or graduate from an accredited program before working in an operating room, while others require formal registration. Most states, however, still rely on employer credentialing and accreditation standards to drive CST adoption. The CST credential issued by the National Board of Surgical Technology and Surgical Assisting (NBSTSA) is the dominant national credential across all regulated states.

Do You Need Certification to Be a Surgical Tech?

At the national level, no single federal law mandates certification for surgical technologists. The requirement — or absence of one — depends entirely on the state where you practice and the accreditation standards of the facility that employs you.

The landscape breaks into three broad tiers:

• States with education and certification laws. A set of states have enacted laws requiring surgical technologists to complete a CAAHEP- or ABHES-accredited educational program and hold a recognized national certification (most commonly the CST) to practice in healthcare facilities.
• States requiring registration. A separate group of states require surgical technologists to register with a state board — typically in conjunction with holding or meeting educational/certification standards — in order to use protected professional titles or to practice.
• States with no specific state requirement. In the majority of states, no state law mandates either certification or registration. In these states, The Joint Commission, Medicare Conditions of Participation, and individual hospital credentialing committees drive CST adoption in practice.

Even where state law is silent, surgical technologist positions at accredited hospitals and ambulatory surgery centers frequently require the CST as a condition of employment. Understanding your specific state's legal framework is essential before entering the workforce.

States That Require Certification or Accredited Education

Thirteen states have enacted laws requiring surgical technologists employed in healthcare facilities to complete a nationally accredited surgical technology program and hold an approved national certification. The CST credential (NBSTSA) satisfies the certification requirement in all of these states. Some states also accept the TS-C credential from the National Center for Competency Testing (NCCT), though Connecticut and New Jersey specifically recognize only NBSTSA-administered certification in their regulatory frameworks — verify your state's approved credential list before sitting for an exam.

The following states require education from an accredited program and/or national certification to practice as a surgical technologist. Specific requirements, implementation dates, and any grandfathering provisions vary by state — see the AST state-law map and your state board for current details.

Source: AST Legislative Overview, ast.org/Public_Policy/Legislative_Overview/ — last verified June 2026. See the AST state-law map and your state board for current details, as effective dates and requirements change.

States That Require Registration

Five states require surgical technologists to register with a state agency. Registration in these states typically requires meeting education and/or certification standards to use a protected professional title or to practice. Requirements and the scope of each state's law differ — see the AST state-law map and your state agency for specifics before acting.

South Carolina is the only state that requires both national certification (CST) and state registration. Surgical technologists in South Carolina must hold the CST credential from NBSTSA and register with the state board before practicing in a healthcare facility.

Source: AST Legislative Overview, ast.org/Public_Policy/Legislative_Overview/ — last verified June 2026.

All States and DC — At a Glance

The full 50-state + DC reference table below uses four categories based on the AST state-law framework. For any state showing "No state requirement," employer credentialing and facility accreditation standards still commonly require the CST.

State laws and effective dates change frequently. Verify current requirements with the AST state-law map and your state board before acting.

How the CST Credential Works

The Certified Surgical Technologist (CST) credential is issued by the National Board of Surgical Technology and Surgical Assisting (NBSTSA) and is the most widely recognized and legally accepted credential for surgical technologists across all regulated states.

Eligibility to Sit for the CST Exam

To sit for the CST exam, candidates must have graduated from a surgical technology program accredited by the Commission on Accreditation of Allied Health Education Programs (CAAHEP) or the Accrediting Bureau of Health Education Schools (ABHES). Those who completed training through a United States Armed Forces surgical technology program are also eligible. The program must include substantial clinical practicum experience — typically at least 120 cases in live operating rooms and 300 to 400 hours of actual surgical experience.

The CST Exam

The CST is a computer-based exam consisting of 175 multiple-choice questions, 150 of which are scored. Candidates have four hours to complete the exam. The NBSTSA publishes detailed eligibility requirements and the current exam blueprint on its website at nbstsa.org.

Maintaining the CST

The CST must be renewed on a regular cycle. Renewal requires demonstrating ongoing professional development through continuing education credits. Specific renewal requirements and cycle lengths are published on the NBSTSA website — confirm current requirements directly with NBSTSA, as policies are subject to change.

The TS-C: An Alternative Credential

The Tech in Surgery — Certified (TS-C) credential is issued by the National Center for Competency Testing (NCCT) and represents a second national certification pathway for surgical technologists. The TS-C is increasingly accepted by employers and is recognized in many states.

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However, the TS-C is not a universal substitute for the CST in regulated states. Connecticut's law specifically references NBSTSA certification, and New Jersey similarly recognizes NBSTSA in its regulatory framework. Before pursuing the TS-C in a state with a certification law, verify that the state's governing body recognizes NCCT as an approved credentialing organization. The AST state-law map and individual state boards are the authoritative sources for this question.

The CST remains the credential specified in the laws of all 13 states with certification requirements, and it is the safer choice for those who may practice across state lines or in heavily regulated markets.

Why Certification Matters Even Without a State Law

In the 33 states (plus DC) where no state law mandates certification or registration, surgical technologists still encounter strong practical pressure to hold the CST:

Accreditation standards. Hospitals accredited by The Joint Commission are required to verify the competency of all surgical personnel. Most facilities interpret this as a requirement for certified surgical technologists in the operating room.

Medicare Conditions of Participation. Facilities participating in Medicare and Medicaid must meet federal conditions that include standards for surgical personnel competency and training.

Employer credentialing. The vast majority of hospitals and ambulatory surgery centers — even in non-regulated states — list CST certification as a required or strongly preferred qualification in job postings.

Salary and advancement. Certified surgical technologists typically command higher starting salaries and have access to broader career paths, including first-assisting roles. See our guide to surgical technologist pay by state for a detailed breakdown.

Travel assignments. If you are considering travel surgical technology work, certification is nearly universally required by staffing agencies and destination facilities — regardless of where the assignment is located.

For candidates currently in school, pursuing the CST from the outset — rather than waiting to see whether your state enacts a requirement — positions you for the broadest possible opportunities. If you are just starting out, our healthcare resume guide for early-career candidates covers how to present your credentials and clinical experience effectively.

Once you are certified, a strong, targeted resume is equally important. Our surgical technologist resume examples show how credentialed candidates present their OR experience and specialty rotations to hiring managers.

FAQs

Q: Do surgical techs need to be certified to work? It depends on the state. Thirteen states require surgical technologists to hold national certification or graduate from an accredited program as a condition of employment in healthcare facilities. Five states require registration. In the remaining states, no state law mandates certification, but employer credentialing and accreditation standards at most hospitals and ASCs effectively require the CST in practice.

Q: Which states require surgical technologist certification? As of June 2026, the states with laws requiring certification or graduation from an accredited surgical technology program are: Connecticut, Idaho, Indiana, Massachusetts, Nevada, New Jersey, New York, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, and Virginia. South Carolina also requires state registration in addition to certification. Requirements and effective dates change — verify current status with the AST state-law map and your state board.

Q: What is the CST credential and how do I get it? The Certified Surgical Technologist (CST) is a national credential issued by the National Board of Surgical Technology and Surgical Assisting (NBSTSA). To earn it, you must graduate from a CAAHEP- or ABHES-accredited surgical technology program (or complete an equivalent military training program), then pass a 175-question computer-based exam. The exam covers anatomy and physiology, surgical procedures, aseptic technique, and related topics. Full eligibility criteria and the current exam blueprint are published at nbstsa.org.

Q: Is the TS-C accepted instead of the CST in regulated states? In most states with no specific state law, employers decide which credentials they accept. In regulated states, the answer varies. All 13 states with certification laws reference NBSTSA or an equivalent nationally recognized certifying body, but some states' regulatory language may not explicitly recognize NCCT as an approved organization. Connecticut and New Jersey specifically recognize NBSTSA in their frameworks. Before sitting for the TS-C as your primary credential in a regulated state, confirm with that state's licensing board that NCCT is an approved credentialing body. The AST state-law map is the starting point for this verification.

Q: Which states require both certification and registration? South Carolina is currently the only state requiring surgical technologists to hold both national certification (CST from NBSTSA) and state registration to practice in healthcare facilities.

Last verified: June 2026. State surgical technologist laws and effective dates change frequently — confirm current requirements with your state and the AST state-law map before acting. This article provides general career information, not legal advice.