COMLEX exam: levels, format, cost and practice questions

What is the COMLEX exam?

COMLEX-USA is the Comprehensive Osteopathic Medical Licensing Examination series of the National Board of Osteopathic Medical Examiners (NBOME). It is the licensure path for DO candidates, and every COMLEX test is computer-based and delivered by Pearson.

How many COMLEX exams are there? NBOME lists three examination levels: Level 1, Level 2-CE (Cognitive Evaluation) and Level 3. They must be taken in sequence, and each level has to be passed before you become eligible for the next one. The former Level 2-PE is listed by NBOME under retired assessments.

Source: NBOME — COMLEX-USA Examination Format. Checked 18 October 2026.

COMLEX exam format by level

Level 1 and Level 2-CE share the same structure: one day, two timed sessions of four hours each, eight sections of 40 questions, 320 single-best-answer multiple-choice questions in total. NBOME reduced both exams from 352 to 320 items starting with the 2026 test cycles.

Level 3 is currently a two-day exam taken within a 14-day window: four sessions of 3.5 hours, 420 multiple-choice questions and 26 clinical decision-making (CDM) cases with two to four questions each. CDM answers can be extended multiple choice, where more than one answer may be required, or short answer.

• Level 1: 320 questions, one day, eight hours of testing
• Level 2-CE: 320 questions, one day, eight hours of testing
• Level 3 until January 12, 2027: 420 questions plus 26 CDM cases, two days
• Level 3 from January 13, 2027: 240 questions plus 16 CDM cases, one day

Source: NBOME — COMLEX-USA Examination Format. Checked 18 October 2026.

The COMLEX Level 3 one-day exam from January 2027

NBOME has confirmed that the COMLEX Level 3 one-day exam starts on January 13, 2027. The new format has four two-hour testing sessions with two sections each: six sections of 40 multiple-choice questions and two sections of eight CDM cases, plus a 10-minute CDM tutorial and 60 minutes of pooled break time.

NBOME says the new format contains fewer test questions but the Blueprint does not change. If you test in late 2026, you sit the two-day version; from the January 2027 window onward, you sit the one-day version.

Source: NBOME — COMLEX-USA Examination Format. Checked 18 October 2026.

Is COMLEX pass/fail?

Only Level 1. Is COMLEX Level 1 pass/fail? Yes: NBOME moved Level 1 from numeric scores to pass or fail reporting in 2022, and the report now comes with a formative performance profile instead of a number.

Level 2-CE and Level 3 are not pass/fail only. Their score reports show a three-digit standard score and a pass/fail designation. The minimum passing score is 400 for Level 2-CE and 350 for Level 3. NBOME states that the share of candidates who pass is not predetermined: the standard is criterion-based and applies to the total exam, not to individual content areas.

Source: NBOME — COMLEX-USA FAQs. Checked 18 October 2026.

How much does the COMLEX exam cost?

The COMLEX Level 1 cost is $745, the same as Level 2-CE. The COMLEX Level 3 cost is $950. These are NBOME examination fees; rescheduling within 30 days of the exam costs extra, rising to the forfeit of $400 (Level 1 and 2-CE) or $500 (Level 3) for a no-show.

Official practice adds to that: COMSAE self-assessment forms cost $60 each for students and residents.

Source: NBOME — COMLEX-USA FAQs. Checked 18 October 2026.

Eligibility, scheduling and attempts

Level 1 requires completion of the first year at an accredited college of osteopathic medicine (COM) and a good-standing attestation by the COM dean. Level 2-CE requires a pass on Level 1 and completion of the second year. Level 3 requires passes on Levels 1 and 2-CE, graduation from an accredited COM and an attestation by your residency program director; NBOME recommends at least six months of residency first.

NBOME advises scheduling at least 120 days ahead; dates are generally open up to six months in advance. You get four scored attempts per level, and once you pass a level you cannot retake it to improve your score.

Source: NBOME — COMLEX-USA Bulletin of Information 2026-2027: Eligibility. Checked 18 October 2026.

Does COMLEX have experimental questions?

Yes. NBOME states that items may be included solely for research or pre-testing purposes and that they do not count toward your score or passing status. Apart from these unscored pretest questions, every question contributes equally to your score.

How many experimental questions on COMLEX Level 1 should you expect? NBOME does not publish the number on the pages checked, and you cannot tell which items are unscored. Treat every question as if it counts.

Source: NBOME — COMLEX-USA Bulletin of Information: Examination Scores. Checked 18 October 2026.

COMLEX pass rates

NBOME publishes COMLEX pass rates for each level on its Examination Performance Data page, updated at the end of each testing cycle. The tables are linked as spreadsheets, and we could not read the current figures on the pages checked, so we do not quote a current pass rate here.

The most recent figures we could verify in NBOME text are historical: an NBOME blog post cites first-time pass rates of 92.7% for Level 1 and 93.2% for Level 2-CE in the 2016-17 academic year. Check the Performance Data page for the current cycle.

Source: NBOME — COMLEX-USA Examination Performance Data. Checked 18 October 2026.

Official COMLEX practice exam options and sample questions

NBOME links COMLEX sample questions for each level that contain the same style and content as the real exam; the Level 3 set includes multiple-choice and CDM questions. NBOME also links a Level 3 CDM tutorial.

For a full COMLEX practice test, NBOME offers COMSAE: Phase 1 aligns with Level 1, Phase 2 with Level 2-CE and Phase 3 with Level 3. Three Phase 1 forms and two Phase 2 forms are available to students, and one Phase 3 form to residents, at $60 per form. So a COMLEX Level 1 practice exam, a COMLEX Level 2 practice exam and a COMLEX Level 3 practice exam all exist from NBOME itself. WelCOM, a self-assessment series on NBOME’s CATALYST platform, adds Phases 1 and 2; there is no WelCOM Phase 3.

NBOME’s practice resources page does not list a COMLEX Level 1 prep course; its own preparation tools are the sample questions, COMSAE and WelCOM.

Source: NBOME — COMLEX-USA Practice Resources. Checked 18 October 2026.

How to study for COMLEX Level 2 and build a COMLEX Level 1 study schedule

Start from the Blueprint, not from a book. For Level 1, NBOME sets minimums of 75% foundational biomedical sciences, 60% application of knowledge and 12% osteopathic principles and manipulative treatment, so OMM cannot be left for the last week. A COMLEX Level 1 study schedule works best backward from your test date: book the date first (NBOME advises 120 days ahead), set one COMSAE Phase 1 form as a baseline, and plan a second one near the end to check progress. That is our recommendation, not an NBOME rule.

How to study for COMLEX Level 2: Level 2-CE moves from foundations to clinical care, so a COMLEX Level 2 study plan should center on clinical presentations and patient management, with COMSAE Phase 2 or WelCOM Phase 2 as checkpoints. Mix COMLEX Level 2 practice questions from all systems rather than studying one organ system at a time, because the real exam mixes them.

Source: NBOME — COMLEX-USA Level 1. Checked 18 October 2026.

How to study for COMLEX Level 3

COMLEX Level 3 prep is different because you study during residency. A realistic COMLEX Level 3 study plan blocks time around rotations, uses NBOME’s Level 3 sample questions and CDM tutorial to learn the case format, and places the single COMSAE Phase 3 form close enough to test day to be meaningful. Your COMLEX Level 3 study schedule also depends on the date: before January 13, 2027 you prepare for two days and 26 CDM cases, after it for one day and 16 cases.

There is no official COMLEX Level 3 study guide beyond the Blueprint and NBOME’s practice resources. Use COMLEX Level 3 practice questions to train the CDM format, where more than one answer may be required, and take at least one full-length COMLEX Level 3 practice test under timed conditions before test day.

Source: NBOME — COMLEX-USA Practice Resources. Checked 18 October 2026.

COMLEX practice questions on Certsqill

Certsqill’s COMLEX practice questions are expert-developed and mapped to the COMLEX-USA Blueprint. If you are comparing a COMLEX question bank, or looking for the best question bank for COMLEX Level 3, look for three things: explanations for every answer option, coverage by Blueprint area, and a clear signal of where you stand.

That is how the Certsqill COMLEX questions work, from COMLEX Level 1 practice questions and COMLEX Level 1 questions on foundational sciences to a COMLEX Level 3 question bank for residents. Every question has an explanation for each answer option, and your results build a readiness score per exam area, so your COMLEX prep focuses on what is still weak. A 7-day money-back guarantee applies.

COMLEX-USA questions people ask

What is COMLEX exam?

COMLEX-USA is the NBOME’s three-level licensure examination series for osteopathic physicians: Level 1, Level 2-CE and Level 3. Source: NBOME, checked 18 October 2026.

Is COMLEX 1 pass/fail, and is COMLEX 2 pass/fail?

Level 1 is reported as pass or fail since 2022. Level 2-CE reports a three-digit score plus pass/fail, with 400 as the minimum passing score. Source: NBOME COMLEX-USA FAQs, checked 18 October 2026.

How many questions are on COMLEX Level 1?

320 single-best-answer multiple-choice questions in two four-hour sessions. Source: NBOME examination format, checked 18 October 2026.

How much does COMLEX Level 3 cost?

$950. Level 1 and Level 2-CE cost $745 each. Source: NBOME COMLEX-USA FAQs, checked 18 October 2026.

Is COMLEX Level 3 a one-day exam?

From January 13, 2027, yes: 240 multiple-choice questions and 16 CDM cases in one day. Until then it is a two-day exam. Source: NBOME examination format, checked 18 October 2026.

How many experimental questions are on COMLEX Level 1?

NBOME confirms unscored pretest questions exist but does not publish how many on the pages checked, 18 October 2026.

Where can I find an official COMLEX practice test?

NBOME offers COMSAE forms for each level at $60 per form, plus sample questions and the WelCOM series for Phases 1 and 2. Source: NBOME, checked 18 October 2026.

How many times can I take a COMLEX level?

Up to four scored attempts per level, and a passed level cannot be retaken to raise your score. Source: NBOME Bulletin of Information 2026-2027, checked 18 October 2026.

COMLEX-USA in detail

• COMLEX scores, score release dates and percentiles →