COMLEX Level 1: format, pass/fail scoring, fees and how to prepare
Last checked October 21, 2026 · Sources: NBOME examination format, FAQ and Bulletin of Information; first-time pass rate as published by colleges of osteopathic medicine from NBOME figures.
COMLEX Level 1 is the first exam in the COMLEX-USA series, usually taken toward the end of the second year of osteopathic medical school. Since May 2026 it has 320 questions over one eight-hour day, it’s reported as pass or fail with a standard of 400, and it costs $745. In the 2025-26 cycle, 90.2% of first-time candidates passed.
COMLEX Level 1 format
| COMLEX Level 1 | |
|---|---|
| Questions | 320 single-best-answer questions, in eight 40-question sections |
| Time | One day, two four-hour sessions; about 1.5 minutes per question |
| Content | Foundational biomedical sciences integrated with osteopathic principles and clinical problem-solving; OPP is at least 12% |
| Scoring | Pass or fail (standard 400) for exams on or after May 10, 2022, with a formative performance profile |
| Fee | $745; late cancellation forfeits up to $400 |
| Attempts | Four scored attempts, per the NBOME |
From the NBOME’s examination format page, FAQ and bulletin, checked October 21, 2026. Per-question time is our arithmetic.
Eligibility and registration
Your college of osteopathic medicine makes you eligible once you’re in good academic and professional standing. You then register and pay in your NBOME account and book a date; the NBOME advises booking at least 120 days ahead. See how to register for COMLEX.
How to prepare for Level 1
- Start with the NBOME blueprint and free sample questions, including the Level 1 practice exam.
- Don’t skip osteopathic principles and practice: OPP is at least 12% of Level 1, and USMLE-focused banks cover it only in supplements.
- Use a COMLEX-style bank: TrueLearn COMBANK has 2,900+ Level 1 questions; AMBOSS lists 5,800+ COMLEX and COMAT questions.
- Take a timed COMSAE Phase 1 (about $60) a few weeks out; it’s 176 items in about 4 hours, roughly half the real exam.
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Is COMLEX Level 1 pass/fail?
Yes. Level 1 has been reported as pass or fail since May 10, 2022, with a standard of 400 and a formative performance profile.
How many questions are on COMLEX Level 1?
320 since May 2026, down from 352, over eight hours.
How much does COMLEX Level 1 cost?
$745, frozen through the 2027-28 cycles, according to the NBOME.
What is the Level 1 pass rate?
90.2% of first-time candidates in the 2025-26 cycle, per NBOME figures published by colleges.
See also COMLEX Level 2-CE, best COMLEX prep and free COMLEX resources. MockTestPrep is independent and is not affiliated with the NBOME.