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USA · Exams · Licensing exams

COMLEX-USA (Level 1, Level 2-CE, Level 3)

COMLEX-USA is the three-level licensing exam for osteopathic physicians (D.O.), and Levels 1 and 2-CE are also graduation requirements at U.S. colleges of osteopathic medicine. Levels 1 and 2-CE cost $745 each and Level 3 $950; Level 3 becomes a one-day exam on January 13, 2027.

Levels3
Level 1 / 2-CE$745Each
Level 3$950One day from Jan 13, 2027
Attempts4Scored attempts per level
Test datesFees and fee helpOfficial practiceMedicine license steps

Made by National Board of Osteopathic Medical Examiners (NBOME). Who: D.O. students (Levels 1 and 2-CE) and osteopathic residents (Level 3). Checked on the owner's own pages, 21 Oct 2026.

Who takes it

  • Required to graduate with a Doctor of Osteopathic Medicine degree from U.S. schools and colleges of osteopathic medicine, and for entry into and promotion within residency.
    NBOME
    COMLEX-USANational Board of Osteopathic Medical Examiners
    Checked
    21 Oct 2026
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  • Level 3 needs Level 1 passed and a clinical skills attestation from your college's dean (the Level 2-PE exam ended in June 2022).
    NBOME
    COMLEX-USA Bulletin of Information: Eligibility (four-attempt limit)National Board of Osteopathic Medical Examiners (NBOME)
    Checked
    21 Oct 2026
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  • Your residency program director must also approve you for Level 3; NBOME recommends at least six months of residency first. From the Class of 2029, the Core Competency Capstone for DOs (C3DO) becomes part of Level 3 eligibility.
    NBOME
    NBOME Frequently Asked Questions (COMLEX-USA fees, attempts, scoring)National Board of Osteopathic Medical Examiners (NBOME)
    Checked
    21 Oct 2026
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  • Limits: four scored attempts per level, and no more than four attempts at a level in 12 months. A passed level cannot be retaken to raise the score.
    NBOME
    COMLEX-USA Bulletin of Information: Eligibility (four-attempt limit)National Board of Osteopathic Medical Examiners (NBOME)
    Checked
    21 Oct 2026
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Format and sections

Computer-based and non-adaptive: the questions and time limits are fixed in advance.

NBOME
NBOME Frequently Asked Questions (COMLEX-USA fees, attempts, scoring)National Board of Osteopathic Medical Examiners (NBOME)
Checked
21 Oct 2026
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LevelWhat it testsFormat
Level 1Foundational biomedical sciences and osteopathic principles, for entry into supervised patient care320 questions in 8 hours (down from 352; NBOME targeted the change for its spring 2026 cycles)
NBOME
Enhancements to COMLEX-USA Exams in 2026-2027National Board of Osteopathic Medical Examiners (NBOME)
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21 Oct 2026
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Level 2-CEClinical sciences, for entry into supervised residency320 questions in 8 hours (same planned change)
NBOME
Enhancements to COMLEX-USA Exams in 2026-2027National Board of Osteopathic Medical Examiners (NBOME)
Checked
21 Oct 2026
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Level 3Unsupervised practice as a generalist osteopathic physicianTwo days now; one day from January 13, 2027, with fewer questions and the same Blueprint (multiple choice plus clinical decision-making cases)
NBOME
COMLEX-USA Level 3 (one-day format from 13 Jan 2027)National Board of Osteopathic Medical Examiners (NBOME)
Checked
21 Oct 2026
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Scoring

  • Level 1 is reported pass/fail only.
    NBOME
    NBOME Frequently Asked Questions (COMLEX-USA fees, attempts, scoring)National Board of Osteopathic Medical Examiners (NBOME)
    Checked
    21 Oct 2026
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  • NBOME sets a criterion-referenced pass/fail standard, so no set share of candidates passes; the standard is reviewed from time to time.
    NBOME
    NBOME Frequently Asked Questions (COMLEX-USA fees, attempts, scoring)National Board of Osteopathic Medical Examiners (NBOME)
    Checked
    21 Oct 2026
    View source

Fees and fee waivers

U.S. dollars:

NBOME
NBOME Frequently Asked Questions (COMLEX-USA fees, attempts, scoring)National Board of Osteopathic Medical Examiners (NBOME)
Checked
21 Oct 2026
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ItemLevel 1 or 2-CELevel 3
Exam fee$745$950
Reschedule or cancel more than 30 days ahead$0$0
Reschedule or cancel 6–30 days ahead$85$170
Reschedule or cancel 1–5 days ahead$250$350
No-show (within 24 hours)$400$500
  • Other fees: score confirmation $75, transcript $65.
    NBOME
    NBOME Frequently Asked Questions (COMLEX-USA fees, attempts, scoring)National Board of Osteopathic Medical Examiners (NBOME)
    Checked
    21 Oct 2026
    View source

Test dates

  • Levels 1 and 2-CE: schedule at least 5 calendar days ahead; NBOME advises trying 120 days ahead because seats are limited. Level 3: register by the deadline for each published testing window.
    NBOME
    COMLEX-USA Bulletin of Information: Registration and SchedulingNational Board of Osteopathic Medical Examiners (NBOME)
    Checked
    21 Oct 2026
    View source

Official practice

  • COMSAE, NBOME's three-phase self-assessment series, lets students and residents gauge their knowledge before each COMLEX-USA level.
    NBOME
    COMSAE: self-assessment series for COMLEX-USANational Board of Osteopathic Medical Examiners (NBOME)
    Checked
    21 Oct 2026
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Used by these careers and colleges

Careers on this site whose step-by-step roadmap includes this exam, and the license it leads to.

The license at the end of this route

Careers that need it

Next on this site

Sources

Where these facts come from

Official and primary sources only, each checked on the date shown. Rules on testing, aid, licensing and immigration change, so confirm a detail with its source before you rely on it.