Occupational therapy session with toddler

How to Pass the COTA Exam

Advance Your Occupational Therapy Assistant Career by Earning COTA Certification

Occupational therapy session with toddler

Congratulations! If you’ve recently finished your Occupational Therapy Assistant (OTA) program (or you will graduate soon) with an associate degree from an ACOTE-accredited institution, you may now qualify to take the Certified Occupational Therapy Assistant (COTA) Exam.

This is a big step in starting your career. Passing the COTA exam certifies you to begin working in your field as an OTA. But it’s essential to carefully prepare and learn how to pass the COTA Exam the first time. You will significantly increase your chances by following a solid study plan. This article serves as a COTA study guide, detailing some of the tips, study aids, and steps you’ll want to follow to ensure success.

If you haven’t already started an OTA program, consider learning more about the job U.S. News ranked #1 in Best Health Career Support Jobs. Click here to learn more about How to Become an Occupational Therapy Assistant.

What is the COTA Exam?

The COTA Exam is the exam you’ll need to take after finishing your OTA program in order to become board certified. Getting certified may be required by your employer and can also lead to increased job opportunities.

The exam is administered by the National Board for Certification in Occupational Therapy (NBCOT®). Passing the COTA Exam ensures you have the knowledge, competency, and skills to work as an OTA nationwide.

Certification can also work in your favor when getting licensed. Ten states currently accept NBCOT certification for fulfilling state licensure requirements: Alaska, Colorado, Maryland, Montana, New Hampshire, New Mexico, Oregon, South Carolina, South Dakota, and Vermont.

Maintaining your certification moving ahead in your career demonstrates you are committed to meeting the highest standards of professional practice and renewing your code of conduct.

How Hard Is It to Pass the COTA Exam?

In 2021, 75% of candidates who had graduated the previous year passed the COTA Exam on the first try. The COTA pass rate indicates that the exam is indeed challenging. Not studying for the exam would be a mistake.

On the other hand, with a focused study plan, passing the exam on the first try is very doable. What makes it a rigorous test is both the questions’ format and the exam’s length. But you can find yourself among the 75% who pass by getting to know the structure, taking practice exams, and working on your weaker subjects.

What score do you need to pass the COTA Exam?

Your overall score is determined by a standardized scale ranging from 300 to 600. A passing score of at least 450 is required for COTA certification. The passing standard is applied to your total number of correct answers across the entire exam (not how well you did in each domain category). This is important to keep in mind as you plan on how to pass the COTA the first time.

What is on the COTA Exam?

The COTA examination includes single-response multiple-choice items as well as six-option multi-select items. The single-response multiple-choice questions include a stem and three or four possible response options. The six-option multi-select items include a question stem followed by six possible responses. Of the options provided, three are correct responses and three are incorrect.

The COTA Exam is made up of three content areas called domains. Under each domain is a set of tasks you will be tested on. You can read about details of each of the tasks for all three sections in the provided content outline. The domains include:

Domain Percent of Exam
Collaborating and Gathering Information: Covers factors that influence occupational performance on an ongoing basis 28%
Selecting and Implementing Interventions: Covers how to implement in accordance with the intervention plan and level of service competence  55%
Upholding Professional Standards and Responsibilities: Covers achieving service competence and applying evidence-based interventions to promote quality in practice 17%

Group of medical students

How Many Questions Are on the COTA Exam?

The COTA examination consists of 200 multiple-choice questions based on the exam content outline. Multiple-choice questions include single-response items in which the candidate must select the best option. Other questions are multi-select items in which the candidate must choose the three best of six provided options.

How Long Is the COTA Exam?

Candidates are allotted four hours to complete the examination. They should pace themselves to give themselves time to answer the 200 questions on the exam. When taking the exam, you can flag items for review and change your responses as testing time allows.

COTA Exam Sample Questions

A significant part of any candidate’s COTA test strategy should be taking practice exams. The practice exams give you a true feeling of the exam format and how you should approach the questions. Following are two COTA sample questions for which you must select the best three answers. Go ahead and try a couple of questions. Then see how you did by checking the answer key at the end of this article.

Sample Question 1:

A client has right homonymous hemianopsia secondary to a CVA several months ago. Deficits in the client’s right visual field interfere with the client’s ability to participate in IADL. One of the client’s goals is to improve visual perceptual skills to resume a hobby of cooking meals using recipes from a favorite cookbook. Which adaptive strategies should the COTA teach the client to use in order to achieve this goal?

Select the 3 best choices.

A. Place boundary markers on the right side of the printed recipe.
B. Use a fluorescent pen to highlight key words in the recipe instruction.
C. Place a ruler under each line of print that is being read on the recipe.
D. Scan the page to search for the first letter of each word in the recipe.
E. Direct eye gaze towards the left margin of the recipe instruction page.
F. Mark off each step of the recipe instructions as it is completed.

Sample Question 2:

An older adult client attending an outpatient rehabilitation facility has severe osteoarthritis of both shoulders. Recently, the client has developed a significant increase in pain and decrease in active shoulder ROM in flexion, extension, internal rotation, and external rotation. The client is not a candidate for a total shoulder arthroplasty. Which assistive devices would be beneficial for the COTA to recommend in order to promote client independence with ADL?

Select the 3 best choices.

A. Flexible sock aid with built-up handles
B. Bath sponge with bendable extended handle
C. Hand-held shower head attachment
D. Long-handled shoe horn with contour grip
E. Self-wipe toilet aid with a curved handle
F. Hook and loop closures for front opening shirts

How Do I Study for the COTA Exam?

How do you create a solid COTA study plan? With this exam, you’ll need to outline a robust strategy and implement various study tools to help you do your best and pass the exam on your first attempt. Remember, you’re taking this exam to start your career as a licensed OTA without having to put off any opportunities while you retake the test. Following are seven tips on how to pass the COTA exam:

1. Get the NBCOT Study Guide

This study guide will help you set up a successful study plan, including test-taking strategies, good study habits, and practice questions with answers, rationales, and references. It’s a good first step in outlining a successful study plan and identifying some COTA test prep tools.

2. Read the NBCOT Certification Exam Handbook

This comprehensive handbook details information and steps to complete and submit a certification exam application successfully. It covers eligibility, the application process, and all requirements you’ll need to be aware of, including transcripts.

It also covers how to schedule for the exam, tips for studying and what to do to prepare for exam day—and what you should do if you find out you need to retake the exam.

3. Consider Buying the NBCOT Exam StudyPack®

The StudyPack is a collection of tools that will test your domain-level knowledge and even allows you to take a complete practice exam. Other tools include mini-tests that provide immediate feedback, partial practice tests, a study guide full of valuable strategies, and Practice Sims™ that let you test your clinical reasoning in a fun, interactive format. The cost for this StudyPack is $75.

Group of students sitting with mobile phones

4. Try Taking a Practice Exam, Cold

Before you even start your studies, consider taking a full practice test to see what it feels like to take a four-hour test. Find out how well you work within the test format and react to multiple-choice and multiple-select questions. You may also get a feel for which content to spend more of your time studying. Three practice tests are available at $30 each.

5. Review the Content Outline

Read through the content outline to understand how much the exam will be weighted for the three content domains. And find out what tasks within each domain you will be tested on. After taking a practice exam, it may become apparent which sections you need to focus on the most.

6. Supplement with More Study Aids

NBCOT provides exam prep flashcards with more than 500 terms and definitions across all domains. You can customize your learning by placing cards in a “Study It” or “Know It” pile as you progress through your learning. Another option is the NBCOT Knowledge Match Game. With this tool, you’ll be tested on matching knowledge statements to the correct categories.

7. Keep Your Body and Mind In Good Shape

You can’t study 24/7. In fact, it’s a great idea to take breaks and participate in physical activities, like going for a run or playing a game of pickleball. It’s a great way to melt the stress away. Another important tip? Get enough sleep each night—especially before exam day. A refreshed mind and body will help you do your best and lead to a real payoff from your studying.

What Training Can Prepare Me for the COTA Exam?

In most cases, an associate degree program from an ACOTE-accredited school is the best option for those seeking a career as an OTA. Most associate degree-granting programs take about two years to graduate. However, the Occupational Therapy Assistant Program at Brookline College can be completed in as little as 96 weeks. ACOTE has granted the Albuquerque, Phoenix, and Tucson campuses Candidacy Status for their associate-degree level programs.

If you want to compare schools in your area, the ACOTE website offers a search tool that allows you to compare by institution type, the status of accreditation, and the state where you want to attend school.

If you’re still exploring your career options, review our article on the 17 Best Entry-Level Medical Jobs in 2023. You’ll notice that OTA is number 4 on the list, with an average annual salary* of $63,000 nationwide.

How Do I Register for the COTA Exam?

You can complete COTA registration after you receive your ATT letter. Candidates can then schedule a testing appointment directly with Prometric. You should only contact Prometric once you receive your letter.

The best way to register is to locate a test center and schedule your exam online. If you prefer to schedule by phone, you should call the Prometric number in your ATT letter. You should avoid calling individual Prometric Test Centers directly to make an appointment.

Where can you take the COTA exam?

A list of Prometric test centers can be found online at www.prometric.com. These COTA testing centers are located throughout the United States (and are also available internationally). COTA test dates are usually available any day during the business hours of the testing center. Scheduling instructions are provided in your Authorization to Test Letter.

How much does it cost to take the COTA exam?

The online initial exam application fee is $515, and $385 for a retake application. The paper initial exam application is $555, and $415 for a retake application. For renewals, the online application is $65, and the paper application is $75.

How many times can you take the COTA exam?

If you don’t pass the COTA on your first attempt, don’t fret. COTA exam requirements for retakes state that you can schedule a second or third attempt within 30 days of your initial exam. You can also schedule a fourth, fifth, or sixth attempt, each 60 days apart. If you need to take the exam a seventh time (don’t worry, this is extremely rare), you must wait six months to schedule the retake.

African-American medical professional with elderly patient

Start on Your COTA Exam Study Plan Today

The right mix of study tools you decide to use in your preparation is entirely up to you. You know which study aids will best work for the ways you like to study. Whether your most beneficial tools will be study tests, flashcards, games—or all of the above—you can build the right study plan for you.

If you’re still deciding on a program, consider the Occupational Therapy Assistant Program at Brookline College. In only 96 weeks, you can prepare to take the COTA exam, become a Certified Occupational Therapy Assistant, and begin a rewarding medical career.

Answer Key:

Sample Question 1: A, C, F

Sample Question 2: B, C, E