- What "PEPS Certification" Actually Means
- How the 12-Station Exam Is Built
- The Five Weighted Competency Domains
- The Electronic Documentation Workflow
- Eligibility, Attempts, and Fees
- Exam Day at the NCCTO
- Reading the Published Results Carefully
- After You Pass: Licensure and Careers
- A Domain-Driven Preparation Sequence
- Frequently Asked Questions
- PEPS is NBEO's Part III licensure exam, not a renewable certification, so no periodic PEPS renewal exists.
- The exam has 12 stations: 10 standardized-patient encounters and two hands-on skills stations, with nine encounters scored.
- Clinical Assessment and Interpretation is the heaviest domain at 29%, followed by Management and Documentation at 25%.
- The fee is USD 1,490 for administrations beginning August 2026, and six total attempts combine former CSE and PEPS tries.
What "PEPS Certification" Actually Means
People searching for "PEPS certification" are usually looking for one specific thing: Part III of the National Board of Examiners in Optometry (NBEO) examination sequence, titled Patient Encounters and Performance Skills (PEPS). It is an entry-to-practice licensure examination for optometry candidates, administered in person at the National Center of Clinical Testing in Optometry (NCCTO) in Charlotte, North Carolina.
That framing matters because the word "certification" suggests a credential you earn, display, and renew every few years. PEPS does not work that way. It is a one-time hurdle, passed once, that supports your path to state licensure. Once you pass, there is no periodic PEPS certificate renewal. Maintaining your license is a separate, state-by-state matter handled by your state board and has nothing to do with retaking this exam.
If you are new to the terminology, our explainers on what PEPS is and what PEPS stands for cover the basics, while this article focuses on how the exam is structured and what it demands of you. For a quick tour of the practice resources that complement this guide, visit the main practice test site.
How the 12-Station Exam Is Built
PEPS is a performance assessment, not a multiple-choice test. You will not click through banks of knowledge questions. Instead, you rotate through stations and demonstrate what you can do in front of standardized patients and with hands-on skills tasks.
The station breakdown
| Component | Detail |
|---|---|
| Total stations | 12 |
| Standardized-patient encounters | 10 (one is unscored data collection, leaving nine scored) |
| Hands-on clinical-skills stations | Two |
| Scored components | Nine scored encounters plus two skills stations |
| Per-station timing | 3-minute observation period, then 15-minute station period |
| Testing session length | 4 hours 30 minutes |
| Breaks | 4-minute breaks, plus a 24-minute extended break after cycle 8 |
| Time on site | Approximately 7 hours including check-in, orientation, and check-out |
What each encounter assesses
The standardized-patient encounters are recorded and evaluate a connected chain of clinical behaviors:
- Focused history-taking
- Clinical interpretation of findings
- Management decisions
- Typed documentation
- Patient education and communication
Because these skills are tested together in a single encounter, you cannot compartmentalize your preparation. A strong clinical decision undermined by a rushed explanation, or a good history followed by a sloppy note, will cost you.
For a candid look at how this format feels from the candidate's chair, see How Hard Is the PEPS Exam?
The Five Weighted Competency Domains
The NBEO blueprint organizes the exam around five weighted competency lines. These are official exam objectives describing what the exam measures. They are not meant to be study-curriculum headings, so use them to understand scoring emphasis rather than as a rigid chapter list.
Domain 1: Clinical Assessment and Interpretation (29%)
The largest weighting on the blueprint. This is where you convert a focused history and examination findings into sound clinical reasoning.
- Synthesizing patient-reported information with what you observe and measure
- Interpreting findings accurately and recognizing what is clinically significant
- Reaching an assessment that is defensible and consistent with the presentation
Domain 2: Management and Documentation (25%)
The second-largest line and one that candidates often underestimate because it feels administrative.
- Selecting appropriate management for the condition presented
- Recording your assessment and plan clearly in the electronic note
- Ensuring documentation matches what you actually did and decided in the encounter
Domain 3: Skills (22%)
Tied to the two hands-on clinical-skills stations, where technique is demonstrated rather than described.
- Performing procedures correctly under timed conditions
- Working with the equipment the NCCTO supplies
- Practicing hands-on routines until they are automatic
Domain 4: Patient Education (13%)
How well you explain conditions, findings, and next steps to a patient in language they can use.
- Translating clinical conclusions into plain language
- Checking understanding rather than simply delivering information
- Connecting your explanation to the management plan
Domain 5: Communication (11%)
The interpersonal layer present in every encounter.
- Building rapport quickly with a standardized patient
- Conducting the encounter professionally and respectfully
- Listening and responding to patient concerns
For a deeper walkthrough of how these areas show up in practice, read the complete guide to all five PEPS content areas.
The Electronic Documentation Workflow
One of the more distinctive features of PEPS is that documentation is typed, not handwritten, and it is part of what is scored. This is an area where candidates who rely on generic assumptions get tripped up.
The blueprint describes an electronic SOAP note. The Candidate Guide, however, specifies Assessment and Plan entries. In other words, do not assume you will be filling in a generic paper SOAP template. Your preparation should follow the current electronic documentation workflow described in the NBEO Candidate Guide for your administration period.
Practical implications
- Practice typing under time pressure. You have a 15-minute station period that includes interacting with the patient and completing your documentation.
- Make your Assessment and Plan internally consistent. What you tell the patient, what you decide, and what you type should all line up.
- Learn the workflow before test day. Review the current Candidate Guide so the interface and expected entries are familiar rather than new.
Key Takeaway
Treat documentation as a skill you rehearse, not an afterthought you finish if time allows. Practice writing a clear Assessment and Plan from a simulated encounter, within the time you would realistically have, until it becomes routine.
Eligibility, Attempts, and Fees
Who can sit for PEPS
Eligible graduation-year students need institutional confirmation from an ACOE-accredited, accredited-with-conditions, or preliminary-approval program. Graduates of eligible accredited programs may also apply, and sponsorship pathways exist for other candidates. Because details can change between administration periods, confirm your own situation against current NBEO policy. Our breakdown of PEPS requirements and eligibility walks through the qualification steps.
Attempt limits
You have six attempts in total, and that count combines former CSE attempts and PEPS attempts. Attempts beyond six require NBEO Board committee approval. This is worth internalizing early: because earlier attempts on the predecessor exam count against you, a candidate with prior CSE history has fewer PEPS attempts remaining than a first-time candidate.
Cost
The exam fee is USD 1,490 for administrations beginning August 2026. Remember to budget beyond the fee itself, since travel to Charlotte and lodging are practical considerations for many candidates. See the full PEPS cost breakdown for planning help, and check PEPS exam dates and scheduling to line up your timeline.
| Item | What to Know |
|---|---|
| Exam fee | USD 1,490 for administrations beginning August 2026 |
| Attempt limit | Six combined attempts across former CSE and PEPS |
| Beyond six attempts | NBEO Board committee approval required |
| Renewal | No periodic PEPS certificate renewal |
| Testing location | NCCTO, Charlotte, North Carolina |
Exam Day at the NCCTO
Logistics are unforgiving on a performance exam, and arriving unprepared on the practical side can derail an otherwise strong candidate.
What you must bring
- Professional attire
- A white lab coat
- Two current signed IDs, including a government photo ID
Your registered name must match your identification. A mismatch is the kind of avoidable problem that is far easier to fix weeks ahead than at check-in.
What you leave behind
Outside notes and electronics are excluded from testing areas. The NCCTO supplies the equipment, so you are not hauling your own instruments to Charlotte. Plan for about seven hours on site once you account for check-in, orientation, the testing session itself, and check-out.
Reading the Published Results Carefully
PEPS is reported pass/fail without a scaled score, unlike Parts I and II. Passing depends on meeting the overall NBEO cut-off. For the specifics of what that means, see the PEPS passing score guide.
When candidates go looking for pass-rate numbers, they often mix up figures drawn from different populations and time periods. Two published data points illustrate the problem:
| Source and Period | Reported Figure | Population |
|---|---|---|
| Published first-time results, July 1, 2024 to June 30, 2025 administration year | 69.0% | First-time results for that administration year |
| NBEO Institutional Yearly Performance Report 2025 | 70.09% (rounded to 70.1% in some school tables) | U.S. first-time Part III CSE/PEPS rate for 1,628 graduates in the October 1, 2024 to September 30, 2025 graduating cohort who attempted all three parts |
These statistics use different populations and periods, and neither is a 2026 or current-version PEPS pass rate. An ultimate all-parts rate is also not the same thing as a PEPS first-time rate. Use them as rough context for how many first-time candidates succeed, not as a prediction for your own outcome. Our PEPS pass rate analysis goes further into interpreting these numbers responsibly.
After You Pass: Licensure and Careers
Passing PEPS clears one major requirement on the road to licensed practice, but it is not the end of the process. State licensure requirements are handled separately, and each state sets its own conditions. Because PEPS is a one-time licensure exam rather than an ongoing credential, your long-term career and earnings depend on factors like practice setting, location, and experience rather than on holding a PEPS certificate. For realistic expectations, explore our earnings analysis, browse what is out there in PEPS-related jobs, and weigh the investment in whether the credential is worth it.
A Domain-Driven Preparation Sequence
Rather than a generic study calendar, build your preparation around the blueprint weights and the practical nature of the exam. The sequence below is one way to allocate effort, tied directly to the domains.
Clinical Assessment and Interpretation (29%)
- Rehearse focused histories across the nine clinical-presentation categories
- Practice moving from findings to a defensible assessment
- Start here because it carries the most weight
Management and Documentation (25%)
- Draft Assessment and Plan entries in the electronic format from the Candidate Guide
- Time yourself so documentation fits inside the station period
- Check that your plan matches what you said to the patient
Skills (22%)
- Drill the hands-on routines until technique is automatic
- Practice under realistic time limits
- Review the Candidate Guide for what the skills stations expect
Patient Education and Communication (24% combined)
- Record yourself explaining a diagnosis in plain language
- Practice opening and closing encounters smoothly
- Run full mock encounters that combine every domain end to end
This is a template, not a mandate. If you are strong on hands-on technique but shaky on writing notes quickly, shift time toward documentation. The point is to weight your effort by what the blueprint rewards and by where you personally are weakest. For a broader framework, see the PEPS study guide, keep the PEPS cheat sheet handy for last-minute review, and use the practice test site to pressure-test your readiness. If you want structured support, our overview of PEPS training outlines your options.
Key Takeaway
Because every encounter blends history, interpretation, management, documentation, and communication, your final weeks should shift from studying domains in isolation to running complete, timed encounters that exercise all of them at once.
Frequently Asked Questions
No. PEPS is Part III of the NBEO examination sequence and functions as an entry-to-practice licensure exam. There is no periodic PEPS certificate renewal. Maintaining your license is a separate matter handled through your state.
There are 12 stations: 10 standardized-patient encounters and two hands-on clinical-skills stations. One encounter is unscored data collection, so nine encounters and the two skills stations are scored.
The fee is USD 1,490 for administrations beginning August 2026. Travel and lodging to the NCCTO in Charlotte, North Carolina are additional costs to plan for.
You have six attempts in total, and that number combines former CSE attempts with PEPS attempts. Attempts beyond six require NBEO Board committee approval.
No. PEPS is reported pass/fail without a scaled score, unlike Parts I and II. Passing requires meeting the overall NBEO cut-off.