- The ACM uses a form-specific, criterion-referenced standard per portion, not a fixed raw-percentage cutoff.
- You must meet the standard on both the core portion and the specialty simulation portion.
- The core has 110 questions, but only 90 are scored; 20 are unscored pretest items.
- The 141-question total is core (110) plus specialty (31), over 210 combined minutes.
There Is No Fixed Percentage Cutoff
Search for the Accredited Case Manager passing score and you will find forum posts quoting a magic percentage. Ignore them. According to the 2026 ACMA/NBCM candidate handbook, passing requires meeting each portion's form-specific, criterion-referenced standard. The handbook does not substitute a fixed raw-percentage cutoff.
In practical terms, "criterion-referenced" means your result is measured against a defined standard of competence for case management practice, not against how other candidates performed on the same day. "Form-specific" means the standard is tied to the particular version of the exam you receive, so the number of items you need to answer correctly can differ slightly from one form to another to keep the standard equivalent.
Two Portions, Two Standards
The ACM exam is not one test with one score. The credential, administered through the American Case Management Association (ACMA) with National Board for Case Management (NBCM) governance, is built from two separate portions:
- A shared core examination taken by every candidate, whether pursuing the ACM-RN or the ACM-SW track.
- A discipline-specific simulation examination that reflects your track (nursing or social work).
Each portion has its own form-specific, criterion-referenced standard. Passing means meeting the standard on both. Strong performance on the core does not offset a miss on the simulation portion, and the reverse is also true. Neither credential replaces the other; the ACM-RN and ACM-SW tracks are both retained.
Key Takeaway
Treat the two portions as two independent hurdles. A candidate who studies only core content and underprepares for the case-based simulation questions can pass one portion and still need to retest the other.
Anatomy of the 141-Question Exam
You will sometimes see the exam described as having 141 questions. That figure is the arithmetic total of the two portions, not the size of the core exam. Here is the breakdown from the 2026 handbook:
| Component | Questions | Time | Notes |
|---|---|---|---|
| Core examination | 110 multiple-choice | 2 hours | 90 scored, 20 unscored pretest items |
| Specialty simulation examination | 31 multiple-choice across 12 simulation cases | 90 minutes | Discipline-specific (RN or SW) |
| Combined total | 141 | 210 minutes | Sum of the two portions |
The unscored pretest items
Of the 110 core questions, 20 are unscored pretest items that ACMA uses to evaluate future questions. You will not know which ones they are. That is why you should give every question your full attention: any item could be the one that counts toward your standard, and there is no way to safely coast on a question that "feels experimental."
How the simulation portion works
The specialty portion presents 12 simulation cases with 31 multiple-choice questions attached. Beginning January 5, 2026, new multiple-choice simulation forms were introduced. This is an important detail for anyone studying from older materials, because earlier descriptions of the simulation scoring used different terminology.
Delivery is through DRC/Pearson VUE, either at a test center or via OnVUE remote proctoring. The exam is offered in English and is based on United States practice. For scheduling windows and deadlines, see our breakdown of ACM exam dates.
Where the Scored Items Sit
The handbook organizes the core examination into three shared content areas with fixed scored-item counts, followed by the single specialty-simulation area. Those counts, not inferred percentage weights, are what you should plan around. The handbook does not publish percentage weights, so any site claiming precise percentages for these areas is making them up.
Screening and Assessment
38 scored core items. This area covers how a case manager gathers and interprets information to understand a patient's needs and risks.
- Identifying patients who need case management services
- Gathering clinical, psychosocial, and financial information
- Recognizing barriers to care and gaps in support
Care Coordination, Intervention, and Transition Management
45 scored core items, the largest core allocation. Expect the most questions here, so it deserves the most study time.
- Coordinating services across the health-care delivery system
- Planning and managing transitions between levels of care
- Matching interventions to patient needs and resources
Process Improvement and Evaluation
Seven scored core items. The smallest area by count, but still part of the standard you must meet.
- Evaluating outcomes of case management activity
- Contributing to quality and process improvement efforts
Assessment, Care Coordination, and Intervention (Specialty Simulation)
The discipline-specific simulation area, tested through the 12-case, 31-question portion rather than the core exam.
- Applying assessment and coordination skills inside realistic case scenarios
- Making decisions as an RN or social-work case manager would
Note that 38 + 45 + 7 = 90, which matches the 90 scored core items. The four headings above do not mean four core domains: three are shared core areas and the fourth is the specialty simulation. For a full walkthrough of each area, read our complete guide to the ACM exam domains.
What Historical Pass Rates Actually Tell You
ACMA's certification FAQ reports 2022 component pass rates, and they are often quoted incorrectly. Here is what the source actually says:
| 2022 Component | Reported Pass Rate |
|---|---|
| RN core | 64.9% |
| RN simulation | 60.3% |
| SW core | 50.2% |
| SW simulation | 67.6% |
Three cautions apply. First, these are component rates, not a combined pass rate for the whole credential. Second, they describe 2022 results, not performance on the revised 2026 exam with its new multiple-choice simulation format. Third, because passing is criterion-referenced, these rates do not reveal a cutoff score; they simply show how candidates fared against the standard that year.
The gap between the SW core rate and the other components is a reminder that difficulty is uneven across portions and tracks. For a fuller discussion of what pass-rate data can and cannot tell you, see ACM pass rate: what the data shows.
Retake Math: Fees and Partial Retests
Because the standard is applied per portion, a failed attempt does not always mean starting over. The retest fees reflect that structure:
| Item | Fee |
|---|---|
| Initial examination fee | $359 |
| Expedited scheduling (add-on) | $46 |
| Retest, both portions | $359 |
| Retest, one portion | $200 |
The financial logic is straightforward: if you miss the standard on only one portion, retesting that single portion costs $200 rather than the full $359. That makes a diagnostic mindset valuable. Knowing which portion fell short lets you concentrate your preparation and your spending. For the complete pricing picture, including renewal, see our ACM certification cost breakdown.
Setting Practical Readiness Targets
Since no fixed percentage exists, how do you know when you are ready? Use proxies that reflect the criterion-referenced design rather than chasing a number you cannot verify.
- Consistency across all three core areas. A strong showing in Care Coordination, Intervention, and Transition Management cannot compensate for neglecting Screening and Assessment. Aim for steady performance in each.
- Reasoning, not recall. Because the simulation portion places questions inside cases, you should be able to explain why an answer is best for a given patient scenario, not merely recognize a term.
- Separate readiness for each portion. Practice the core format (110 questions in two hours) and the simulation format (31 questions over 12 cases in 90 minutes) as distinct skills.
- Stamina. The combined exam runs 210 minutes of testing time. Rehearse sitting through long blocks of focused work.
Our free ACM practice tests are designed to help you check consistency across areas and build timing for both portions. Use missed questions to find patterns rather than treating any practice percentage as a predicted score.
Key Takeaway
Because the pretest items are unscored but unmarked, and the standard shifts by form, "good enough" is a moving target. Prepare to be comfortably competent everywhere, with extra depth where the scored item count is highest.
Scheduling Domains by Score Risk
If you have a few weeks, sequence your study by where the scored items sit and where the format is least familiar. This is one way to order a focused plan, and you can adjust the length to your calendar.
Screening and Assessment (38 scored items)
- Review how needs, risks, and barriers are identified
- Practice questions on information gathering and prioritization
Care Coordination, Intervention, and Transition Management (45 scored items)
- Spend the most time here: it is the largest core allocation
- Work through transitions between levels of care and service coordination
Process Improvement and Evaluation (7 scored items) plus simulation practice
- Cover outcomes evaluation and quality concepts efficiently
- Drill the 12-case simulation format with timed sets
For a more complete preparation framework, see our ACM study guide and the one-page ACM cheat sheet for last-minute review.
Frequently Asked Questions
There is no single published percentage. The Accredited Case Manager exam uses a form-specific, criterion-referenced standard for each portion, and you must meet the standard on both the core and the specialty simulation portion to pass.
The core portion has 110 multiple-choice questions (90 scored, 20 unscored pretest items) in two hours. The specialty portion has 31 multiple-choice questions across 12 simulation cases in 90 minutes. Together that is 141 questions and 210 minutes.
You must meet the standard on both portions to earn the credential. If you fall short on only one, you can retest that single portion for $200 instead of paying the $359 fee to retest both.
No. The 2022 rates are separate component figures for RN and SW core and simulation, not a combined rate, and they predate the revised 2026 exam with its new multiple-choice simulation forms.
Care Coordination, Intervention, and Transition Management carries the largest core allocation at 45 scored items, so it deserves the most study time. Still, keep Screening and Assessment (38 items) and Process Improvement and Evaluation (7 items) in rotation, and practice the simulation format separately.