COMLEX format and scoring: questions, passing scores and fees by level
First checked October 12, 2026; rechecked October 21, 2026 · Sources: NBOME’s own format pages, news release, FAQ and Bulletin of Information. NBOME says fees are frozen at 2025 levels through the 2027-28 cycles.
COMLEX format and scoring in brief: COMLEX-USA is the three-level exam sequence for osteopathic physicians, run by the NBOME. Level 1 is pass/fail, Level 2-CE gives a numeric score, and from May and June 2026 Levels 1 and 2-CE were cut from 352 to 320 questions. Level 3 moves to a one-day exam in January 2027.
The three levels
| Level | Format | Scoring | Fee |
|---|---|---|---|
| Level 1 | One day, two four-hour sessions. 320 single-best-answer questions from May 2026, in eight 40-question sections per NBOME’s format page. | Pass or fail for exams on or after May 10, 2022 (400 standard). | $745 |
| Level 2-CE | One day, computer-based, eight hours. 320 questions and revised breaks from June 2026. | Three-digit score; 400 to pass. | $745 |
| Level 3 | Currently two days. NBOME says it moves to one day effective January 13, 2027, keeping a similar mix of multiple-choice questions and clinical decision-making cases. | Three-digit score; 350 to pass. | $950 |
From the NBOME’s format pages, FAQ and bulletin.
How COMLEX scoring works
- Criterion-based: you pass by meeting the standard, not by beating a fixed share of candidates.
- Level 1: pass or fail, with a formative performance profile showing strengths and weaknesses, per the NBOME.
- Levels 2-CE and 3: a three-digit score plus pass or fail; Level 2-CE percentiles are interim until the cycle ends.
- Whole exam: the pass decision is based on your overall result, not individual content areas.
The clinical skills exam
NBOME says the Level 2-Performance Evaluation was suspended in March 2020 and formally discontinued in June 2022. Starting with the graduating class of 2029, it says new options for assessing and verifying osteopathic clinical skills will be part of the eligibility requirements for Level 3.
Common questions about COMLEX format and scoring
What is the Level 1 pass rate?
90.2% of first-time candidates passed in the 2025-26 cycle, per NBOME national figures published by colleges of osteopathic medicine. See our COMLEX pass rates page for Levels 2-CE and 3.
Do I get any feedback with a pass/fail result?
Yes. The NBOME says Level 1 results include a formative performance profile alongside the pass or fail result.
How many questions are on COMLEX?
320 for Level 1 (since May 2026) and Level 2-CE (since June 2026), over eight hours.
What is the passing score?
400 for Levels 1 and 2-CE and 350 for Level 3.