The NCMHCE format: 11 case studies now, 10 from July 1, 2027
The National Clinical Mental Health Counseling Examination (NCMHCE) is a case-study exam. This page explains how a case is built, how long you have, how it is scored and what changes in 2027, with a link to the NBCC document behind each fact.
The short version
| Now (through June 30, 2027) | From July 1, 2027 | |
|---|---|---|
| Cases | 11 case studies. One is unscored and you cannot tell which. | 10 case studies |
| Questions | 130 to 150 multiple-choice questions, 100 of them scored. Each case has 9 to 15 questions. | 130 to 150 questions, 30 to 50 of them unscored field-test items. Each case has 9 to 15 questions with four answer options. |
| Exam time | 225 minutes (3 hours 45 minutes) inside a 255-minute session that also covers the agreement, the tutorial and the break | 225 minutes, with an optional 15-minute break halfway |
| Break | One scheduled 15-minute break after the fifth case study | Optional break halfway; the first half locks once you submit it |
| Scoring | One point per scored question, so the maximum is 100. The passing score is set by standard setting and adjusted for each form by statistical equating. NBCC publishes no single cut score. | Scaled scores from 100 to 500. A 360 passes on every form. |
| Where | A Pearson VUE test center, or online through Pearson VUE OnVUE | The specifications do not address delivery |
One detail people miss: the session is 255 minutes, but the exam itself is 225. If you practice with a 255-minute clock, you are practicing with thirty extra minutes.
How a case works
- Each case comes in three sections: an initial intake summary, then two later counseling sessions.
- Each section opens with a piece of the narrative, followed by multiple-choice questions about it.
- You can review your answers inside a section. Once you continue to the next section, you cannot go back to the earlier ones.
- NBCC says the questions measure application and higher levels of thinking, the way a counselor works through a real case.
That last point is why case practice beats memorizing. How to read a case, the first lesson of the free course, walks through one.
What the cases test
| Domain | Percent of scored items |
|---|---|
| Professional Practice and Ethics | 15 |
| Intake, Assessment, and Diagnosis | 25 |
| Areas of Clinical Focus | Tested through the diagnoses and cases on each form, not item by item |
| Treatment Planning | 15 |
| Counseling Skills and Interventions | 30 |
| Core Counseling Attributes | 15 |
From July 1, 2027 the NCMHCE uses the same six domains and weights as the 2027 NCE: Professional Development and Counselor Self-Awareness 15, Intake and Assessment 18, Treatment Planning and Continuity of Care 15, Provision of Counseling Interventions 20, Indirect Client Care 12, and Legal and Ethical Compliance 20 percent.
How it is scored
Today your score is the number of scored questions you answered correctly, out of 100. A panel of subject matter experts sets the passing score through standard setting, and equating moves it up or down slightly for each form so that an easier form does not get an easier pass. Your score is never compared with other candidates' scores. From July 1, 2027, scores move to a 100 to 500 scale with 360 as the passing point on every form.
Registering, cost and retakes
- Your state board decides which exam you take and approves you to sit. Then you register in the Credentialing Gateway and wait for the Authorization to Test email from Pearson VUE.
- Your board grants a window of up to six months. You can reschedule up to 24 hours before the appointment for a $50 fee.
- The fee is not one national number. NBCC-hosted state forms list $275 (Ohio, New York), $200 (Nebraska) and $195 (Nevada). The amount at checkout is the one that applies to you.
- Official scores go to your board within 30 days.
- If you do not pass, you wait 30 days from your test date before retesting, unless your board requires longer. Each retake is a new registration and fee.
Step by step: How to register for the NCMHCE. Not sure which exam your state wants? NCE or NCMHCE: which one do you need.
Practice cases, free
- 48 practice cases built the way the NCMHCE builds them, with a new daily case you can try without signing in.
- The baseline case, to see where you stand first.
- The free six-lesson NCMHCE course and the 12-week NCMHCE study plan.
- NCMHCE flashcards, and one full case on the free sample page.
- Taking the NCE instead? NCE exam facts, checked the same way.
Sources and change log
Checked on November 13, 2026 against these documents.
- NBCC, Candidate Handbook for State Licensure: NCMHCE (revised November 20, 2025)
- NBCC, NCMHCE Content Outline (revised October 8, 2025)
- NBCC, NCMHCE Examination Specifications, effective July 1, 2027
- NBCC, About the NCMHCE
- NBCC, Exam Registration (state licensure)
- NBCC, State Board Directory
- NBCC-hosted Ohio examination supplement (NCE and NCMHCE, $275)
- NBCC-hosted New York registration form (NCMHCE, $275)
- NBCC-hosted Nebraska registration form (NCE and NCMHCE, $200)
- NBCC-hosted Nevada examination supplement (NCE and NCMHCE, $195)
Change log. November 13, 2026: page published. Every fact checked against the documents above.