Heading into this round, seven of the 12 sides are in contention for a World Cup berth.
For this round, the dozen clubs were placed in three groups of four. The section winners qualify for the finals, with the two best runners-up entering the interconfederation playoffs.
The most fascinating thing is the fact that all seven teams can qualify, enter the playoffs, or be eliminated on Tuesday. Here are the scenarios for each of the sides with something to play for.
Suriname on the cusp of maiden World Cup appearance
Group A has Suriname and Panama hoping to finish top heading into Tuesday's matches. The former currently heads the group on goal difference, but there is still a lot on the line.
Suriname, aiming to make their first showing at the World Cup finals, face Guatemala away. Panama, hoping to make their second appearance in the final tournament, host El Salvador. Both Guatemala and El Salvador were knocked out on Thursday.
The scenario is simple for both Suriname and Panama: should one team earn more points than the other on the night, that side will qualify for the finals. If they both draw, Suriname will qualify on goal difference.
However, if both teams win - or lose - it will be goal difference determining the team qualifying. Natio hold an advantage of three goals over Los Canaleros.
For the playoff spot, if both sides prevail on Tuesday, the second-place finisher will qualify as one of the best runners-up. Depending on results in Group C, that might not even matter. If either Haiti or Honduras lose, then second place in Group A will make the playoffs regardless.
Finally, if the second-place side in Group C finish on nine points, then goal difference may come into play should Suriname or Panama come second with nine points.
Remarkably, either of the top two could be eliminated despite going unbeaten. Should they draw their match and finish second, they could end up being the worst runner-up despite not losing once in this qualifying cycle.
Jamaica and Curacao do battle
Group B is much more straightforward going into the final round. Trinidad and Tobago and Bermuda, who meet in Port of Spain, are already eliminated. That clash is the only one on Tuesday with nothing on the line.
Perhaps the biggest match of the night will come in Kingston, as Jamaica host Curacao in a winner-take-all battle. Dick Advocaat's Curacao went back in front on Thursday after their win in Bermuda, while the Reggae Boyz conceded late on to draw in Trinidad.
Jamaica, who previously qualified for the World Cup in 1998, will return to the finals if they win. Any other result will see Curacao make their bow in the final tournament.
Fortunately for The Blue Wave, they are almost sure to enter the interconfederation playoffs should they lose. That is a certainty should any of Suriname, Panama, Honduras or Haiti fail to win. Even if Honduras or Haiti finish second on 11 points in Group C, their goal difference will likely be inferior to Curacao's.
Even if all four prevail, whosoever finishes second in Group C would have to make up a significant goal difference disadvantage, which Curacao lead by seven over Honduras and nine on Haiti.
As for Jamaica, if they draw, the scenario is identical to Curacao's regarding making the playoffs. Even with a loss, entering the intercontinental mini-tournament would be very likely, so long as at least one of Suriname, Panama, Honduras, or Haiti drop points. The only way they get knocked out is if they are beaten and the aforementioned quartet all win.
Pressure mounts for trio in Group C
The most chaotic group of the lot comes in Group C, as Honduras, Haiti, and Costa Rica are all fighting for top honours. La Bicolor, despite their shocking loss to Nicaragua on Thursday, have the advantage in what has been an incredibly competitive section.
Honduras are away to Costa Rica, while Haiti play host to Nicaragua, who are eliminated. This is where things get interesting. All three sides could still finish top here.
Honduras and Haiti are in the same boat. If one win and the other do not, the winner will qualify for the finals. Victories for both teams will force goal difference to decide top spot, with Honduras - who reached the finals in 2010 and 2014 - owning a two-goal cushion. Haiti's only other entry in the finals came in 1974.
A defeat for either or both teams will spell elimination, as they would be the worst of the three runners-up. Should either or both draw, they will have to depend on Panama losing, and/or Suriname doing the same, though goal difference would come into play.
Meanwhile, Costa Rica must win to have any chance of at least finishing second. If they prevail and Haiti do not, Los Ticos will earn top spot. If both they and Haiti claim three points, then Costa Rica will qualify for the playoffs with a Panama loss and/or a Suriname defeat, providing that the goal difference gap of three gets nullified.
Costa Rica will be out if they fail to come out on top in Tuesday's game. Even if they win though, it may not be enough. A win from Haiti, and both Suriname and Panama avoiding defeat would spell the end of their hopes of a seventh World Cup showing.
Follow the final round of CONCACAF World Cup qualifying on Flashscore.