The NCMHCE: case studies, format, scoring and retakes, for the New York LMHC

Who takes it in New York

NYSED: “To meet the examination requirement for licensure as a Mental Health Counselor in New York State, you must pass the ‘National Clinical Mental Health Counselor Examination (NCMHCE),’ administered by the National Board for Certified Counselors (NBCC). The National Counselor Examination (NCE) from NBCC is not acceptable for licensure.”

• Before you can take it: Form 1 and the $371 fee, your school's Form 2, and NYSED's approval of your education. NYSED tells you and the examination administrator when you're eligible; then you register with the administrator
• NYSED won't approve you for the exam before you receive your graduate degree (8 NYCRR 79-9.2(b))
• Your supervised hours aren't a condition: you can take it before they're done

How to become an LMHC in New York

How many questions are on the NCMHCE?

130 to 150 multiple-choice questions across 11 case studies, 100 of them scored; one case study is unscored. Each case has 9 to 15 questions, each with four options and one correct answer. There is no penalty for guessing.

How a case study works

• Each case comes in three sections: an intake summary and two counseling sessions, each followed by its questions
• Once you move on to the next section, you can't go back to review or change your answers in the one before
• The client's initial diagnosis is given at the start of the case. NBCC's format chart says you may be asked about co-occurring diagnoses, or to change a diagnosis as the case goes on

How long is the NCMHCE?

225 minutes of testing, with one scheduled 15-minute break after the fifth case study. With the 5-minute agreement and the 10-minute tutorial, the session is 4 hours and 15 minutes. Testing online, you can't go back to the first five case studies after the break.

What it covers

NBCC's content outline (revised October 8, 2025), from a job analysis finalized in June 2019, weights its six domains this way:

• Counseling Skills and Interventions, 30%
• Intake, Assessment, and Diagnosis, 25%
• Professional Practice and Ethics, 15%
• Treatment Planning, 15%
• Core Counseling Attributes, 15%
• Areas of Clinical Focus, 0%: the diagnoses and presenting problems most common in clinical work, covered through the variety of cases on each form rather than by single questions

How much does the NCMHCE cost?

NBCC's current handbook doesn't print the amount: it says to submit the appropriate fee, that exam fees aren't refundable or transferable, and that rescheduling costs $50. NBCC's New York supplement, written in 2017, listed $275 and said fees are subject to change. The fee is paid to NBCC, not NYSED; check the amount when you register.

Your test window

Once registered, you have up to six months, set by the state board, to take it. If you don't test within that window, your registration and fees are forfeited.

Scoring

• The highest possible score is 100. The passing score is set by a standard-setting study and equated across versions, so it varies slightly from one version to another; NBCC publishes no single passing number
• In New York, the passing score is determined by the State Board for Mental Health Practitioners (8 NYCRR 79-9.2(c))
• At a test center you get an unofficial score report. NBCC sends official scores to your state board, about four weeks after you test

If you don't pass

NBCC's handbook says you must wait 30 days from your test date, unless the state sets a longer wait, and register and pay again; the number of attempts is up to your state board. NBCC's New York supplement, written in 2017 for the earlier format, said to wait at least three months. We found no NYSED page that sets a wait: ask NBCC before you register again.

What changes on July 1, 2027

NBCC's examination specifications, effective July 1, 2027, from a new work analysis finalized in October 2025:

• 10 case studies, each still an intake summary and two counseling sessions
• 130 to 150 questions, of which 30 to 50 are field-test questions
• 225 minutes, with an optional 15-minute break halfway; once you submit and the break begins, you can't return to those questions
• Scores from 100 to 500, with a passing point of 360 on every form, and general feedback for each domain
• Six new domains: 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%, Legal and Ethical Compliance 20%

Practicing for it

NBCC's handbook includes a sample case study, and NBCC posts a version of it as a separate PDF. The NBCC Foundation sells a study guide for the current format ($34.95, with six practice cases). Practice material that describes separate Information Gathering and Decision-Making sections, each with its own passing score, is for the format NBCC retired.