COMLEX-USA explained: the three levels, fees, scoring and 2026-27 changes
Last checked October 21, 2026 · Sources: the NBOME’s COMLEX-USA, examination format, exam day and FAQ pages; national pass rates as published by colleges from NBOME figures.
COMLEX-USA is the licensing exam sequence for osteopathic physicians, run by the NBOME. It has three levels, taken in order: Level 1 (pass/fail) and Level 2-CE (scored) during medical school, then Level 3 in residency. The 2026 and 2027 changes shorten Levels 1 and 2-CE to 320 questions and move Level 3 to one day on January 13, 2027. Fees are $745 for Levels 1 and 2-CE and $950 for Level 3, and exams are delivered at Pearson VUE test centers.
The three COMLEX-USA levels
| Level | When | Format | Scoring | Fee | First-time pass rate |
|---|---|---|---|---|---|
| Level 1 | End of year 2 | 320 questions, 8 hours | Pass/fail (400) | $745 | 90.2% (2025-26) |
| Level 2-CE | Years 3-4 | 320 questions, 8 hours | Three-digit; 400 to pass | $745 | 92.5% (2025-26) |
| Level 3 | Residency | Two days now; one day from Jan 13, 2027 | Three-digit; 350 to pass | $950 | 97.1% (2025) |
From the NBOME’s pages, checked October 21, 2026.
The path to licensure
Your college makes you eligible; you register and pay in your NBOME account and book a Pearson VUE seat, ideally 120+ days ahead.
A dedicated study period built on the NBOME blueprint, with osteopathic principles at least 12% of Level 1.
Pass Level 1, then Level 2-CE; you have four scored attempts at each level.
During residency, with a clinical skills verification and your program director's attestation.
Everything on COMLEX-USA
320 questions, pass/fail, $745.
→Scored, 400 to pass, $745.
→One day from January 13, 2027; $950.
→320 questions, pass/fail Level 1, $745 fees.
→Levels in order, attestations, attempt limits.
→NBOME registration and cancellation fees.
→An 8-week dedicated plan with weekly OPP.
→Pearson VUE check-in, breaks and timing.
→90.2% first-time on Level 1, passing scores.
→Testing windows to April 2027.
→Osteopathic content, scoring and taking both.
→320 items, one-day Level 3, fee freeze.
→NBOME sample questions and COMSAE.
→Every NBOME page you need.
→Reddit, Quora and outdated claims.
→COMLEX prep
AMBOSS 4.2, COMBANK 4.1, UWorld 4.0, Lecturio 3.7.
→Six head-to-head comparisons.
→From free NBOME practice to $199.
→Codes, trials and bundles.
→Our rubric and how we rate.
→Where DO students talk about COMLEX
Osteopathic students compare resources and score experiences in r/medicalschool and COMLEX threads across Reddit, and on Quora. Many posts predate the 2026 changes, so check formats with the NBOME. See our COMLEX community guide, and our USMLE guide if you’re taking both.
Common questions about COMLEX-USA
Is there still a clinical skills exam?
No. NBOME says the clinical skills exam, Level 2-PE, was discontinued in June 2022, and new ways to verify clinical skills apply from the class of 2029.
How much does COMLEX cost?
$745 each for Levels 1 and 2-CE and $950 for Level 3, frozen through the 2027-28 cycles.
Where do I take COMLEX?
At Pearson VUE test centers; the NBOME now partners with Pearson to deliver COMLEX-USA.
What score do I need to pass COMLEX?
400 for Levels 1 and 2-CE (Level 1 is reported only as pass or fail) and 350 for Level 3.