Background and Objective: Tuberculosis (TB) is a major public health problem in Nepal. It is a major cause of ill-health, one of top ten causes of deaths and leading cause of death from single infectious agent. Government of Nepal has put TB as a priority program and is committed to eliminate TB. The aim of the study was to describe the problem of TB epidemic in Nepal. Methods: Different literatures, reports, policy documents and guidelines were reviewed and the Results were presented through descriptive analysis. Results: In 2018/19, Nepal conducted the first National TB Prevalence survey, which showed higher prevalence, incidence and mortality of TB than the previous estimations. The TB prevalence was estimated to be 416/100000 with around 117000 people with TB disease in the country living. Similarly, the incidence was found to be 245/100000 with an estimated of 69000 cases. The mortality was also found to be 3.1 times higher than the previous estimates. In the year 2020/21, National TB Programme (NTP) registered 28,677 (38% females and 62% males) cases with nearly 58% missing cases than the projected cases showing higher incidence notification gap. The missing cases were higher among elderly due to challenges in access to health care services. Of the registered cases, the proportion of childhood TB was found to be 6.6% which was low suggesting existence of high TB transmission and requiring early diagnosis and treatment of childhood TB. The case notification rate (CNR) was 95 per 100000 population and 9 districts were considered to be high TB burden districts based on the CNR. Conclusions: There exists a huge gap between the estimated and notified cases. NTP must work to reduce the gap and identify the missing cases through accountable, equitable, quality, universally accessible and patient centered care and services.