COMLEX Level 3: the move to one day in 2027, scores, fees and eligibility
Last checked October 21, 2026 · Sources: NBOME Level 3 page, examination format, FAQ and 2026-27 enhancements news; session lengths from an NBOME presentation to the New York State Board for Medicine (March 2025); first-time pass rate as published by colleges from NBOME figures.
COMLEX Level 3 is the final COMLEX-USA exam, taken during residency. It’s currently a two-day exam of about 14 hours, but from January 13, 2027 the NBOME is changing it to a one-day exam with fewer questions and the same blueprint. The passing score is 350, the fee is $950, and 97.1% of first-time candidates passed in 2025.
Level 3 format: before and after January 13, 2027
| Until January 2027 | From January 13, 2027 | |
|---|---|---|
| Length | Two days, about 14 hours of testing | One day; NBOME’s plan shows about 8 hours |
| Content | Multiple-choice questions plus clinical decision-making (CDM) cases | Similar mix of multiple-choice and CDM cases, fewer questions |
| Blueprint | COMLEX-USA blueprint | Unchanged, per the NBOME |
| Scoring | Three-digit score; 350 to pass | Same passing standard |
From the NBOME’s Level 3 and format pages; session lengths from the NBOME’s March 2025 presentation to the New York State Board for Medicine.
Eligibility for Level 3
- Pass Levels 1 and 2-CE first; the levels must be taken in order.
- Your residency program director makes you eligible.
- Six months of residency is recommended by the NBOME before you test.
- Clinical skills verification: the current attestation runs through the class of 2028; from the class of 2029, new options apply, with C3DO expected to become the standard.
Level 3 fees and cancellation
The Level 3 fee is $950, frozen through the 2027-28 cycles. Cancelling or rescheduling more than 30 days ahead is free; inside 30 days, the NBOME keeps $170 to $500 of the fee depending on timing, with $500 forfeited for a no-show. Level 3 also has registration deadlines for each testing window. See how to register.
How to prepare for Level 3
- Practice CDM cases, which are specific to Level 3; the NBOME’s sample questions include them.
- Use a Level 3 bank: TrueLearn sells a COMLEX Level 3 bank alongside its Level 1 and 2-CE products.
- Take a Level 3 COMSAE to rehearse timing.
- Plan around the change: if you test after January 13, 2027, expect one long day rather than two.
Common questions about COMLEX Level 3
When does COMLEX Level 3 become one day?
On January 13, 2027, according to the NBOME. The new format has fewer questions but the same blueprint.
What is the passing score for Level 3?
350, on a three-digit scale; Levels 1 and 2-CE use 400.
How much does Level 3 cost?
$950, frozen through the 2027-28 cycles.
When should I take Level 3?
The NBOME recommends at least six months of residency first; your residency program director makes you eligible.
See also COMLEX Level 2-CE, COMLEX changes and score release dates. MockTestPrep is independent and is not affiliated with the NBOME.