PA-CN Requirements 2026: Eligibility, Prerequisites & How to Qualify

What This Credential Actually Is

The label "PA-CN" is a convenient shorthand, but the official credential is the Certificate of Added Qualifications in Nephrology, issued by the National Commission on Certification of Physician Assistants (NCCPA). Those who earn it use the designation PA-C, CAQ-Neph. It is a specialty add-on for physician assistants who already hold PA-C certification, not an entry-level credential, not a nephrology nursing certification, and not a physician nephrology-board examination.

That distinction matters when you read the requirements. Every prerequisite is built around the idea that you are an experienced, certified PA who has been working in nephrology and wants a formal, exam-validated credential for that work. If you are still exploring what the credential is, our overview What Is PA-CN Certification? covers the basics, and What Does PA-CN Stand For? clears up the naming. This article focuses on the harder question: can you qualify, and how do you document it?

Requirements at a Glance

Before the detail, here is the full picture. NCCPA's policies governing the CAQ program (last reviewed May 2026) and its non-exam requirements policy define the following path to the credential.

Notice that ACLS is not on this list as a mandatory item. It is recommended, but it is not an additional required course.

Foundation: PA-C Status and Unrestricted Licensure

Two baseline conditions apply before anything else counts. First, you must currently hold PA-C certification from NCCPA. Second, you need unrestricted U.S. PA licensure, or unrestricted practice privileges granted by a government agency, which covers PAs employed in federal settings.

The word "unrestricted" carries real weight here. NCCPA's wording means every license you hold must be free of restrictions, not merely your primary one. If you maintain licenses in multiple states, confirm the status of each before you apply. A restriction on a secondary license you rarely use can still create an eligibility problem, and it is far easier to discover that early than after you have submitted fees and documentation.

The Hours Requirement: 4,000 Total, 2,000 in Nephrology

This is the requirement candidates misread most often. NCCPA asks for 4,000 hours of total PA practice, and at least 2,000 of those hours must be in nephrology. It is not 4,000 hours of nephrology. A PA with 4,000 hours of general practice and only 1,000 in nephrology falls short, while a PA with 2,000 nephrology hours and 2,000 hours elsewhere in PA practice meets the threshold.

The hours must fall within the six years before you attest that the experience requirement has been satisfied. Older experience does not count toward the window, so a PA who left nephrology years ago and returned recently should calculate only the qualifying recent hours.

How to Count Your Nephrology Hours

• Include time spent managing patients in clinic, inpatient consultation, dialysis units, and transplant settings, provided the work is genuinely nephrology practice.
• Keep your own running log with dates, practice settings, and approximate hours. Your attesting physician or lead PA will be signing off on your practice, and a clear record makes that conversation easy.
• Do not assume part-time schedules disqualify you. The requirement is hours, not duration, so part-time practice simply takes longer to accumulate.

If you are a few months short on nephrology hours, that is useful information for timing your application. Our guide to PA-CN exam dates, testing windows, and deadlines helps you work backward from when you want to test.

Nephrology CME: 75 Credits in Six Years

You must document 75 nephrology-focused Category I CME credits earned in the six years before you apply for the exam, with at least 25 of those earned in the preceding two years. The two-year minimum exists to show current engagement, so a pile of credits from five years ago cannot carry you alone.

Two points deserve attention. The credits must be nephrology-focused, which means general CME on unrelated topics will not satisfy this requirement even if it is Category I. And the figure here is 75, not any older summary you may have seen citing a higher number. Older 150-credit summaries do not reflect the current requirement, so rely on NCCPA's policy documents rather than secondhand lists.

Where Nephrology CME Typically Comes From

• Conference sessions on CKD management, dialysis modalities, transplant medicine, and hypertension
• Online courses and grand-rounds-style programs with Category I designation
• Society meetings and review courses that explicitly credit nephrology content

Because the credits double as exam preparation, choose offerings that map onto the exam's content categories. A session on glomerular disease or acid-base disorders earns credit and sharpens knowledge you will be tested on. For how those categories break down, see PA-CN Exam Domains: Complete Guide to All 11 Content Areas.

The Attestation: Who Signs and When

The attestation is the non-exam requirement that trips up people who plan everything else well. NCCPA requires a signed form confirming your procedural and patient-management knowledge and performance in nephrology. There is no separate timed practical assessment. The signature stands in for it.

Who Can Sign

• A collaborating physician who works in nephrology and knows your practice
• A lead or senior PA who works in nephrology and knows your practice
• For PAs enrolled in or graduated from a postgraduate program, the program director (a physician or PA) may sign

The signer must actually know your work. A department chair who has never observed you is a weaker choice than the nephrologist you round with daily.

What the Form Addresses

The form covers relevant knowledge and performance, including management within at least one of the listed nephrology practice settings: end-stage renal disease, chronic kidney disease, kidney transplantation, or acute inpatient dialysis. The key phrase is "at least one." You are not required to work in every nephrology subspecialty. A PA who focuses on outpatient CKD management and has no transplant exposure can still qualify.

Timing Flexibility

The attestation may be submitted before the exam or within 90 days after score notification. That flexibility is useful: if your signer is unavailable at the moment you want to schedule, you do not have to delay testing. Just do not let the 90-day window lapse after you pass.

Application Mechanics and Fees

The initial fee is $350 total: $100 for registration/administration and $250 for the examination. Testing is delivered at Pearson VUE test centers. The initial exam is not offered through a remote option; online administration applies only to maintenance exams later in the credential's life.

For a fuller view of what else you might spend, including optional preparation purchases, see PA-CN Certification Cost: Complete Pricing Breakdown. NCCPA also sells an optional $50 practice exam, which we discuss below.

Order of Operations

1. Verify PA-C status and the unrestricted status of every license.
2. Tally your hours and confirm you meet or will soon meet the 2,000 nephrology-hour floor.
3. Document your 75 nephrology CME credits, confirming at least 25 fall in the last two years.
4. Identify and brief your attestation signer.
5. Apply, pay the fees, and schedule at Pearson VUE.
6. Submit the attestation before testing or within 90 days of your score notification.

What the Exam Covers and How It Is Delivered

Meeting the requirements gets you to the exam; the exam determines the credential. The initial test is 120 multiple-choice questions in two 60-question blocks, with 60 minutes per block. The two-hour timer excludes a 15-minute tutorial and a 15-minute break. It is closed book, and personal calculators, notes, and books are prohibited. Once you finish a block, you cannot return to its questions, so commit to your answers and manage time within each block.

Content Categories

NCCPA's content blueprint lists eleven medical content categories. The weights are official, and the examples under each category in the blueprint are illustrative rather than exhaustive.

Chronic Kidney Disease is the heaviest category at 20%. Some third-party summaries label that category differently, but the issuer's heading is Chronic Kidney Disease, and that is the term to study under.

The Separate Task Distribution

The exam is also classified by task type, which cross-cuts the same questions rather than adding new topics: History and Physical 7%, Diagnostic Studies 20%, Diagnosis 25%, Managing Patients 35% (including health maintenance, clinical intervention, and pharmaceutical therapeutics), Applying Scientific Concepts 10%, and Legal/Ethical Issues and Emerging Topics 3%. Do not add the 35% management share to the medical content weights; they describe the same 120 questions from two angles.

For a category-by-category treatment, read our full domains guide, and for a realistic read on difficulty, see How Hard Is the PA-CN Exam?. A numeric passing threshold and an official specialty-specific pass rate have not been verified, so be wary of any source quoting precise figures; our pass rate article and passing score article explain what is and is not publicly confirmed.

Planning Your Six-Year Window

Two six-year clocks run in this process, and keeping them straight prevents surprises. The hours must fall within six years before you attest that the experience requirement is satisfied. The CME must fall within six years before exam application. And the entire initial CAQ process must be completed within six years after initiation.

A practical way to use that time is to build a backward-looking checklist now, then a forward-looking study plan. One compact approach tied to the blueprint:

NCCPA's free Sample Nephrology Questions & Critiques document is the best starting point for question style, and the optional $50 practice exam (one form for this specialty, with a 180-day completion window) offers educational feedback, though that feedback does not predict whether you will pass. A fuller plan lives in our PA-CN study guide, and you can drill question formats with the practice questions at our main practice test site.

After You Pass: Ten-Year Validity and Renewal

Understanding what comes after helps you judge whether the effort is worthwhile. Scores generally arrive eight to ten weeks after administration, following validation. The CAQ is valid for ten years as long as your PA-C certification and licensure remain current.

Renewal requires 125 nephrology Category I CME credits earned during the cycle and submitted by the time of the maintenance-exam application, plus passing the specialty examination again. Maintenance can be taken at a test center or online. The online maintenance version keeps 120 questions but allows five minutes per question within an approximately six-week window, permits references, and prohibits assistance from others. Those conditions are specific to maintenance; they do not apply to the initial exam.

Whether the credential pays off financially is a separate question, and we avoid assuming a pay premium. For a careful discussion, see Is the PA-CN Certification Worth It?, and for the employment picture, PA-CN Jobs.

Frequently Asked Questions