NCBTMB - Board Certification for Massage Therapists

NCBTMB – Board Certification for Massage Therapists

Massage therapists and other bodywork professionals often seek advanced certifications and credentials to demonstrate their mastery of specialized skills and commitment to their profession. This could be a massage specialty such as sports massage or lymphatic massage, or it could be a general massage board certification. The largest and oldest professional organization in the US that provides a national board certification for massage is the NCBTMB.

What is the NCBTMB? NCBTMB, which stands for National Certification Board for Therapeutic Massage & Bodywork, is an independent organization that offers board certification for massage therapists who pass their certification exam (BCETMB) and meet other specific requirements. The NCBTMB has also established standards for continuing education providers to ensure high quality CE courses for practitioners who need to renew their license or certification.

In this article, you’ll find the answers to many commonly asked questions about NCBTMB board certification such as how to become a certified massage therapist in 2024, and what is on the NCBTMB exam. We’ll also cover the key differences between the board certification exam (BCETMB) and the massage licensing exam (MBLEx). This information is relevant for therapists preparing to take the MBLEx because you are likely to see one or more questions about the NCBTMB on the MBLEx.

NCBTMB massage therapy board certification organization logo

About the NCBTMB

The National Certification Board for Therapeutic Massage & Bodywork, Inc., also known as NCBTMB, is a professional massage organization in the US. This private, independent non-profit organization was founded in 1992 and is headquartered in Illinois. NCBTMB is governed by an elected 5-person board of directors. The purpose of this national massage board is to provide a credible and recognized certification program that fosters high standards of ethical and professional therapeutic massage or bodywork practice, and assures the competency of practitioners. NCBTMB has developed a Code of Ethics and Standards of Practice to provide guidance for board certified therapists regarding these professional standards.

The NCBTMB promotes a culture of professional excellence within the massage therapy community. It works to elevate the profession by ensuring that certified massage and bodywork practitioners are competent, safe and ethical. NCBTMB also functions to ensure that continuing education providers meet the highest standards through their Approved Provider program. Many states require approved NCBTMB CE (CEU) hours to renew a state massage license.

Brief history of the NCBTMB

The NCBTMB was founded in 1992 by a group of massage therapy professionals with the goal of establishing standards of excellence at a national level. These massage professionals, along with educators, authors, school owners, and AMTA Board members collaborated to develop the NCETMB. By the mid 1990’s, many US states were using the NCBTMB’s exam as part of their licensing requirements. This exam also functioned to facilitate reciprocity between states.

In 2014, The FSMTB’s MBLEx became the nationwide entry-level massage licensing exam, and the NCETMB was retired as a licensing exam. The NCBTMB continued to grow as the provider of the nation’s leading massage certification exam. It also collaborated with massage education providers to offer several specialty certificate programs and examinations which included sports massage, clinical rehabilitative massage, oncology massage, palliative care massage, and reflexology. These specialty certificates previously offered by NCBTMB were discontinued in 2022.

What is board certification in massage therapy?

Board certification is a voluntary process in which a professional fulfills certain requirements such as training, experience and examination. Many health professions including physicians, physical therapists, and psychologists have one or more types of board certification. This certification may be generalized or specialized for therapists who want to work in a specific massage therapy niche.

To be “Board Certified” as a massage therapist refers to a practitioner who has passed the BCETMB offered by the NCBTMB. Board certification (BCTMB) is promoted by the NCBTMB as being the “highest credential within the massage and bodywork profession”.

Massage therapists can also become certified in various advanced massage specialties through other education and certification providers. For instance, a therapist may pursue a massage specialty certification in lymphatic massage, sports massage, medical massage, geriatric massage, etc.

Massage certification and licensing acronyms

The following is a quick reference table of acronyms relevant to the NCBTMB and massage certification and licensing. Knowing the difference between these will be helpful for therapists who are beginning a career in massage therapy or are preparing to take the MBLEx.

AcronymWhat it isWhat it stands for
NCBTMBOrganizationNational Certification Board for Therapeutic Massage & Bodywork
BCETMBExamBoard Certification Exam in Therapeutic Massage & Bodywork (current)
BCTMB®CredentialBoard Certification in Therapeutic Massage & Bodywork
NCETMBExamNational Certification Exam for Therapeutic Massage & Bodywork (*No longer offered)
NCETMExamNational Certification Exam for Therapeutic Massage (*No longer offered)
FSMTBOrganizationFederation of State Massage Therapy Boards
MBLExExamMassage & Bodywork Licensing Exam (current)

Check out our other article on massage abbreviations for a more complete list of massage acronyms and abbreviations for documentation.

What are the NCBTMB Standards of Practice?

The NCBTMB Standards of Practice are a set of guiding principles that were developed and adopted to provide NCBTMB board certified massage therapists with a clear statement of expectations regarding ethical and professional conduct. In addition, these standards of practice are intended to assist non-therapists with understanding the role and responsibilities of NCBTMB certified therapists. These non-therapists include:

  • Massage clients and the general public
  • Other health and wellness professionals
  • State or local regulatory agencies

The standards listed below apply to NCBTMB certified massage therapists. These guidelines are enforced by the NCBTMB, and represent the minimum levels of practice that BCTMB therapists must demonstrate. Each of these standards includes multiple specific guidelines which you can view on the NCBTMB website. Board certified therapists who fail to comply with the NCBTMB Code of Ethics and Standards of Practice are considered to have engaged in professional misconduct. This may result in disciplinary actions including sanctions, suspension or revocation of certification.

Standard I: Professionalism

The first NCBTMB standard regards professionalism as a massage therapist. This includes many aspects including promoting healing and well-being, providing responsible and respectful touch, using professional communications, ensuring client health and safety, maintaining a hygienic practice, assessing client needs, developing a plan of treatment, acquiring informed consent, using appropriate draping, abiding by NCBTMB rules and regulations, and more.

Standard II: Legal and Ethical Requirements

NCBTMB Certificants must also comply with all applicable legal requirements of the jurisdiction in which the massage therapist works. Specific criteria defined by this professional standard include obeying local, state and federal laws, refraining from unethical actions, maintaining accurate records, and reporting any infractions, legal or ethical violations to the NCBTMB.

Standard III: Confidentiality

Board certified massage therapists (BCTMB) must respect client confidentiality and safeguard client information and records. BCTMB certified therapists must securely retain client files for 4 years from termination of the therapeutic relationship, and dispose of client records in a secure manner.

Standard IV: Business Practices

BCTMB massage therapists must demonstrate honesty, integrity and lawfulness in all massage business practices. Specifically, therapists must provide a safe and healthy physical setting for their clients, maintain adequate massage liability insurance, have accurate documentation, avoid conflicts of interest, market their business truthfully and appropriately, maintain accurate financial records, abide by municipal, state and federal legal regulations, and more.

Standard V: Roles and Boundaries

NCBTMB Certificants are required to maintain ethical boundaries and adhere to their professional role in order to protect and foster the therapist-client therapeutic relationship. This includes recognizing personal limitations (e.g., limits of training) and avoiding practicing beyond these limitations. Board certified therapists must also respect client’s freedom of choice and right of refusal, recognize and limit the effects of transference or counter-transference, refrain from practicing while under the influence, work within their scope of practice, and more.

Standard VI: Prevention of Sexual Misconduct and Inappropriate Touch

All professional massage therapists, including board certified therapists, are required to refrain from sexual misconduct. BCTMB therapists are to refrain from pursuing any personal relationship with a client for a minimum of six (6) months after termination of a therapist-client therapeutic relationship.

Please see the NCBTMB website for additional specific details regarding these Standards of Conduct.

What is the NCBTMB Code of Ethics?

The NCBTB has also developed their own code of ethics that applies to NCBTMB Certificants. The following is a summary of the 18 items listed on their code of ethics. Visit the NCBTMB ethics page of their website for a full description of these items.

  1. Have a sincere commitment to provide high-quality massage & bodywork.
  2. Represent qualifications honestly (e.g., education, professional affiliations), and only work within scope of training.
  3. Accurately inform clients and others of the scope and limitations of their discipline.
  4. Acknowledge the limitations and contraindications of massage and bodywork. Make referrals to appropriate healthcare professionals when needed.
  5. Provide treatment only when indicated (i.e., when there is a reasonable expectation of client benefit).
  6. Strive for professional excellence. Consistently maintain and improve knowledge and competence through continuing education.
  7. Conduct massage business and professional activities with honesty and integrity.
  8. Do not discriminate against clients or health professionals.
  9. Protect client confidentiality.
  10. Obtain informed consent from all massage clients or client advocate.
  11. Respect each client’s right to refuse or terminate treatment at any time.
  12. Provide appropriate draping in a way that maintains each massage client’s comfort, safety and privacy.
  13. Exercise the right to refuse to treat any person or part of body when reasonable and just cause is present.
  14. Refrain from participating in sexual relationship or conduct with current clients.
  15. Avoid any interest or activity that may conflict with acting in the best interest of the client or profession.
  16. Respect client autonomy and boundaries (e.g., physical, emotional, beliefs, disclosure, etc.).
  17. Refuse any gifts intended to influence a referral, decision or treatment.
  18. Follow the NCBTMB Standards of Practice, Code of Ethics, and all guidelines, regulations, etc. issued by the National Certification Board for Therapeutic Massage & Bodywork, Inc.

MBLEx vs. NCBTMB exam…What’s the difference?

The MBLEx offered by the FSMTB, and the BCETMB offered by the NCBTMB are both massage exams that test a therapist’s knowledge of massage-related subjects. However, there are several differences in the content and purpose of these two massage exams. MBLExGuide is dedicated to helping massage students pass the massage licensing exam. You can learn more about the MBLEx and take a MBLEx practice test here. The following table highlights some of the key differences between these massage tests.

Stands forMassage & Bodywork Licensing ExamBoard Certification Exam for Therapeutic Massage & Bodywork
Administrated byFederation of State Massage Therapy Boards (FSMTB)National Certification Board for Therapeutic Massage & Bodywork (NCBTMB)
Exam Purpose / TypeLicensing exam
(required by most states for license)
Certification exam
FormatComputerized, multiple-choice questionsComputerized, multiple-choice questions
Number of Questions100 questions140 questions
Time Limit120 minutes140 minutes
EligibilitySome massage training
(MBLEx application and testing can be completed
before finishing massage school)
Must be licensed or have graduated from NCBTMB Assigned School
(see details in FAQ section below)
Renewal RequirementsNA
(does not need to be renewed)
24 CE hours, $140 renewal fee
(see more details in FAQ section below)
Difficultyentry-leveladvanced (not entry-level)
BCETMB Exam Questions Categories and Breakdown

BCETMB exam content outline

The board certification exam offered by NCBTMB has 140 questions and covers six domains or content areas. Each domain of the BCETMB includes core knowledge and skills that a massage therapist needs to master for that domain. Most of the questions on the BCETMB are practical and scenario-based, and focus on client assessment and clinical application of massage and bodywork techniques. The following table breaks down the content covered in each section of the NCBTMB exam (i.e., the BCETMB).

I. Massage Modalities, Techniques, and Manual Forces (20%)

General massage protocols; Compression; Tension & decompression; Friction; Shearing force; Torsion; Range of Motion (ROM); Stretching; Pin & Stretch technique; Bending; Muscle Energy Techniques (MET); PNF; MFR; Hydrotherapy; Indications and Contraindications; Tapotement; Vibration; Client positioning; Special populations (e.g., pregnancy, oncology); Massage tools; Body mechanics; Benefits and effects of various massage techniques and types of massage and bodywork (styles/forms); Understanding of common bodywork modalities. • Choose appropriate massage techniques
• Apply massage techniques safely
• Perform massage on special populations (e.g., athletes, geriatric, prenatal)
• Identify contraindications and apply affective techniques
• Identify fundamental characteristics of bodywork modalities
• Perform proper body mechanics while working with different populations
• Position clients for comfort and safety

II. Applied Science (25%)

This content area of the BCETMB is similar to the first three content areas of the MBLEx (i.e., A&P, kinesiology, pathology for massage).

Anatomy (structure) of the human body including tissues, joints, and the origins, insertions, actions and innervations of muscles (muscle OINA).
• Physiology (function) of systems of the body, especially the muscular system, skeletal system and nervous system. Intermediate knowledge is required on the integumentary, cardiovascular, lymphatic and digestive system. And basic knowledge of the respiratory, endocrine, reproductive and urinary systems is required.
• Kinesiology, including concepts of body mechanics, movement, levers, agonist & antagonists, synergists, etc.
• Pharmacology, including prescription and non-prescription contraindications for massage, the effects and interactions of massage for clients taking certain medications, etc.
• Standard precautions
Endangerment sites for massage therapy
• Identify structures and functions of all body systems
• Identify muscle and joint physiology
• Recognize mechanics of body movement (e.g., agonists, antagonists, synergists)
• Identify and apply range of motion techniques, including passive (PROM), active (AROM), assisted (AAROM) and resisted range of motion
• Identify areas of caution for massage (endangerment sites)
• Recognize muscle and orthopedic testing
• Identify massage indications and contraindications as related to common prescription drugs
• Determine proper stretching techniques and joint end-feel.

III. Professional Communication (15%)

• Medical terminology for massage therapists
• Communicating with massage clients and patients in understandable terms
• Understand massage documentation and reporting formats including massage SOAP notes, treatment planning, medical history, and electronic medical reporting (EMR)
• HIPAA (Health Insurance Portability and Accountability) concepts
• Verbal and non-verbal communication for health professionals
• Informed consent for massage therapy
Communicate effectively with massage clients when explaining massage or bodywork treatment plans.
• Use proper medical terminology when working with other healthcare professionals
• Describe massage techniques, anatomy, physiology and kinesiology in understandable terms
• Identify & adhere to HIPAA confidentiality standards
• Adapt client communication and intervention to verbal and non-verbal cues. Work within client comfort levels.
• Document treatment sessions appropriately based on work setting

IV. Professionalism & Ethics (10%)

• Understand the current standard of care for safe and effective massage and bodywork
• Professional boundaries, transference and countertransference
• Draping laws and techniques
• Understand professionalism and ethics when referring clients to other healthcare professionals
• Know when, why and how to refuse treatment
• Know procedure of how to report misconduct
• Maintaining proper physical and emotional boundaries
• Respecting the client’s right of refusal
• Identify when it is appropriate to refer a client out, and to whom referrals should be made
• Identify situations of transference and countertransference
• Identify when it is appropriate to refuse to treat a client
• Identify correct entities to report a client or fellow massage therapist’s misconduct

V. Laws & Business Practices (5%)

• Appropriate draping
• Continuing education requirements
• Scope of practice and applicable massage licensing laws
• Record keeping (business and client/clinical records)
• Maintain client confidentiality
• Perform only within the massage therapy scope of practice
• Maintain appropriate draping for client protection, comfort and privacy
• Represent educational and professional qualifications honestly
• Demonstrate proper business and client record keeping
• Abide by national massage organizations’ code of conduct and policies
• Comply with all federal, state and local laws and regulations

VI. Assessment (25%)

• Comprehensive intake
• Interview and data collection techniques
• Observation techniques (e.g., posture, movement)
• Range of motion (normal and abnormal)
• Concepts of customized treatment planning in collaboration with client and other healthcare professionals
• Indications, contraindications and clinical reasoning
• Functional massage assessments and reassessments
• Pain assessment, pain scales, and concepts of pain management
• Medical terminology (e.g., SOAP charting…)
• Massage therapy research
• Understand how to conduct a comprehensive massage intake interview
• Interpret client health history information
• Develop custom treatment plans to meet each client’s individual needs and treatment goals
• Communicate with clients about their treatment plan
• Modify a treatment plan if needed
• Assess pain using appropriate pain scale
• Perform various assessment skills (e.g., posture assessment, gait assessment, special tests, ROM assessment)
Document massage assessment and treatment plans accurately
• Collaborate with other health professionals and communicate appropriately using correct medical terminology
• Work effectively as a member of an integrated health care team
• Identify and analyze research relevant to the practice of massage

What to know about the NCBTMB for the MBLEx

Since the NCBTMB is an important massage organization in the US, there’s a good chance that you may see one or more questions about it on the MBLEx massage exam. Here are a few examples questions about the NCBTMB that you could see on the MBLEx. The answers to these questions are found within this blog post:

  • How much continuing education is required biannually to renew NCBTMB board certification?
  • What role does NCBTMB have within the massage profession?
  • What is the purpose of the NCBTMB Standards of Practice?
  • What are 2-3 examples of items listed in the NCBTMB Code of Ethics?
  • How long must a massage therapist refrain from entering into a personal relationship with former client after termination of client-therapist relationship?
  • What are some of the disciplinary actions that a board certified massage therapist might face in the event of professional misconduct?
  • What are some examples of professional misconduct for BCMTB certified massage therapists?

Frequently asked questions about the NCBTMB certification exam

What does NCBTMB stand for?

NCBTMB stands for National Certification Board for Therapeutic Massage & Bodywork.

What is the highest massage certification?

The highest massage certification is Board Certification in Therapeutic Massage and Bodywork. Therapists who receive this massage credential through the NCBTMB can use the “BCTMB” credential after their name as long as they maintain their certification by renewing it every two years.

What are the benefits of NCBTMB and becoming certified?

There are pros and cons of pursuing board certification in any profession. The benefits of becoming a board certified massage therapist through the NCBTMB include enhanced credibility among massage employers, colleagues and clients. Adding “board certified” to your massage bio may help massage therapists attract new clients when marketing massage services. Also, mentioning that you are board certified during a massage interview can potentially help you land a great job. Board certification demonstrates that a therapist has advanced client assessment and critical thinking skills. Many therapists seek board certification for professional development and as a personal challenge. BCTMB practitioners can also get listed in the NCBTMB directory and receive discounts through the NCBTMB affiliate program with other businesses such as EarthLite and Custom Craftworks.

What is the pass rate for NCBTMB board certification exam?

The BCETMB has a pass rate of 63% (2022). Compare this to the MBLEx pass rate which fluctuates from 59% (November 2021) to 73% (May 2022).

How long is the NCBTMB exam?

The NCBTMB board certification exam consists of 140 questions that are on topics from massage assessment and applied sciences to professional communication and ethics. The content areas and percentages are outlined in the table above. Candidates have 140 minutes to take the exam.

Are there any NCBTMB exam prep study resources available?

Yes, there are many BCETMB study guides and other NCBTMB exam prep resources that can easily be found online. The NCBTMB offers an online practice exam as well as a study guide outline on their website.

What is the BCETMB exam?

The BCETMB, which stands for Board Certification Exam in Therapeutic Massage & Bodywork, is the exam currently offered by NCBTMB. Massage therapists must pass this exam to become a board certified massage therapist. It is offered at Prometric testing sites around the country.

How many questions are on the BCETMB exam?

The BCETMB is computer-based, multiple-choice exam with 140 questions. Candidates have 140 minutes to complete the test.

How do I become a board certified massage therapist?

The NCBTMB board certification requirements include:

  • Verification of a current massage therapy license (if practicing in a state that requires a massage license)
    • OR, graduation from a NCBTMB Assigned School (if practicing in a state that does not require state licensure)
  • Passing score on the Board Certification Exam (BCETMB)
  • Pass a criminal background check
  • Agree to uphold the NCBTMB Standards of Practice and Code of Ethics

How much does board certification cost?

It costs $275 to apply for board certification through the NCBTMB (in 2024).

What massage exam is offered by the NCBTMB?

The NCBTMB currently only offers the Board Certification Exam for Therapeutic Massage & Bodywork (BCETMB). This is the exam that practitioners must pass to become a board certified massage therapist in the US.

What is the application process for NCBTMB board certification?

Massage therapists who are interested in becoming board certified through the NCBTMB can apply online. First create an account on the NCBTMB website, then click on the “Board Certification Application” link and complete the application form and all necessary requirements.

Who is eligible to take the NCBTMB certification exam?

Currently licensed massage therapists or practitioners in an unlicensed state who have graduated from a NCBTMB Assigned School may sit for the BCETMB upon approval of their completed application.

What are the continuing education and NCBTMB renewal requirements?

Board Certificants must re-certify every two years to keep their board certification. Massage continuing education is a big component of the NCBTMB renewal process. During this time, BCTMB massage therapists are required to earn 24 continuing education credits from NCBTMB CE approved providers. Three (3) of these CE hours must be in ethics. Only up to 4 CE hours in self-care for massage therapists will be accepted. Therapists may also take CE courses in anatomy, physiology, kinesiology and business. Board Certificants are also required to pay a $140 renewal fee, pass a criminal background check and agree to uphold the NCBTMB Standards or Practice and Code of Ethics in order to renew their certification.

What does NCBTMB approved mean?

The NCBTMB has established standards for continuing education (CE) providers. A NCBTMB approved provider has met these standards. A NCBTMB approved course is one that meeds their standards for a specific continuing education course. Massage therapists can find hundreds of NCBTMB courses online.

What is a NCBTMB Assigned School?

A NCBTMB assigned school is an educational institution that has been approved by the National Certification Board for Therapeutic Massage and Bodywork. Criteria for approval requires a minimum of 500 hours training curriculum in Western based massage therapy education. The curriculum must include 125 hours of A&P and kinesiology, 200 hours of supervised, in-class hands-on instruction, 40 hours of pathology, 10 hours of business and ethics, and 125 hours in related content. A NCBTMB assigned schools list is available on their website.

What is the difference between the NCBTMB and the FSMTB?

These are two separate organizations. The NCBTMB developed and administers the massage board certification exam. They also established standards for continuing education providers. The FSMTB created and administers the MBLEx which is the massage licensing exam.

Is the BCETMB harder than the MBLEx?

Yes. Since the MBLEx is an entry-level exam and the BCETMB assesses therapists on advanced massage skills and knowledge, most candidates will find the NCBTMB exam to be more difficult. That being said, many students also find the MBLEx difficult. Many of the same test-taking and study strategies that work for the MBLEx will also work when preparing for the NCBTMB exam.

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