Real-time simulation of modular multilevel converter (MMC)-based HVDC is one of the most important and difficult technologies in the area of utility-scale power electronics research. This paper describes an efficient modeling approach for real-time simulation of MMC-HVDC. Taking advantages of the full parallel architecture of the field-programmable gate array (FPGA), more than 1500 submodules are able to be simulated in a single FPGA. The design details of the physical MMC control system are also presented. The presented MMC-HVDC real-time simulator and physical control system are successfully performed in the Nan-ao Island MMC-HVDC project, which is the world’s first three-terminal MMC-HVDC system for research on operation and fault characteristics. The results validate the accuracy of proposed approach and real-time MMC simulator.