COMLEX requirements and eligibility: order, attempts and Level 3 rules
First checked October 12, 2026; rechecked October 21, 2026 · Sources: NBOME’s Bulletin of Information (Eligibility), Level 3 eligibility page and FAQ. State licensing rules from the Michigan Administrative Code as an example.
The core COMLEX requirements: you must take the COMLEX-USA levels in order and pass each one before the next: Level 1, then Level 2-CE, then Level 3. Your college’s dean (or, for Level 3, your residency program director) must attest that you’re in good academic and professional standing, and you have four scored attempts at each level.
COMLEX requirements by level
| Level | Prerequisites | Who makes you eligible | Fee | Passing standard |
|---|---|---|---|---|
| Level 1 | Good standing at your college of osteopathic medicine | Your COM dean | $745 | Pass/fail (400) |
| Level 2-CE | Passed Level 1 | Your COM dean | $745 | 400 |
| Level 3 | Passed Levels 1 and 2-CE; clinical skills verification; 6 months of residency recommended | Your residency program director | $950 | 350 |
From NBOME’s eligibility rules and FAQ, checked October 21, 2026.
Attempt limits
- The NBOME allows four scored attempts at each level; waivers of the limit have strict conditions.
- State boards may be stricter. Michigan, for example, allows no more than 6 attempts at any level and requires all levels to be passed within 7 years of first passing one.
- Your college may set its own deadlines for when you must pass Levels 1 and 2-CE to progress and graduate.
Clinical skills for Level 3
Since the Level 2-PE exam ended in 2022, Level 3 eligibility needs a clinical skills verification. The NBOME says the current attestation runs through the class of 2028; from the class of 2029, new assessment options apply, with its C3DO assessment expected to become the standard. Level 3 itself becomes a one-day exam on January 13, 2027.
A typical timeline
Usually toward the end of the second year of medical school, once your COM makes you eligible.
Usually in the third or fourth year, after core clinical rotations.
During residency, with the NBOME recommending at least six months of residency first.
Common questions about COMLEX requirements
Do I have to take the COMLEX levels in order?
Yes. You must pass Level 1 before Level 2-CE, and both before Level 3.
How many times can I take COMLEX?
Four scored attempts at each level, per the NBOME; some state boards set lower limits or time limits.
Who decides when I'm eligible?
Your college of osteopathic medicine for Levels 1 and 2-CE; your residency program director for Level 3.
Do I still need the Level 2-PE?
No. The Level 2-PE ended in 2022; Level 3 eligibility now uses a clinical skills verification.