Overview
COMLEX-USA is the licensing examination series for osteopathic physicians in the United States. It is run by the National Board of Osteopathic Medical Examiners (NBOME). It tests osteopathic medical knowledge, clinical skills and other competencies needed to practise as a generalist osteopathic physician.
The series has three sequential levels. Passing all of them is a requirement for the Doctor of Osteopathic Medicine (DO) degree and for entering and progressing through residency and unsupervised practice.
Who can apply
Candidates become eligible through their college of osteopathic medicine (COM) or, for Level 3, their residency programme director.
Level 1: completion of the first year at an accredited COM, plus the dean's attestation of good academic and professional standing.
Level 2-CE: a pass in Level 1, completion of the second year at an accredited COM, and the dean's attestation of good standing.
Level 3: passes in Level 1 and Level 2-CE, graduation from an accredited COM, an attestation of good standing from the residency programme director, and a clinical skills attestation from the COM dean or a pass in Level 2-PE. Six months of graduate medical education is recommended.
Each level allows four scored attempts in total, and no more than four attempts in any 12-month period, counting incomplete or voided attempts. Only a medical licensing agency can request an exception for a fifth attempt. A candidate who has passed a level cannot retake it to raise the result.
Levels or stages
Level 1
Usually taken in the second year of medical school. It is reported as pass or fail only. Passing candidates receive a Formative Performance Profile that compares their performance, overall and by content area, with other first-time test takers who passed. A new break structure applies to Level 1 sittings from 7 May 2026.
Level 2-CE
A one-day, computer-based exam taken in the third or fourth year. It combines clinical science knowledge with physician competencies.
Level 3
Taken during residency. It is currently a two-day, computer-based exam. From 13 January 2027 it becomes a one-day exam with fewer questions.
Exam pattern
All levels are computer-based and are organised around two dimensions. The first is seven competency domains: osteopathic principles, practice and manipulative treatment; osteopathic patient care and procedural skills; application of knowledge for osteopathic medical practice; practice-based learning and improvement; interpersonal and communication skills; professionalism and ethics; and systems-based practice. The second is ten clinical presentation areas, ranging from community health to the integumentary system.
For Level 2-CE, the blueprint lists minimum shares for each domain. The largest are 30 percent for osteopathic patient care and procedural skills and 26 percent for application of knowledge for osteopathic medical practice. The clinical presentation minimums run from 5 percent (for example the integumentary system) to 13 percent (musculoskeletal system). NBOME has announced changes to the number of items on Level 1 and Level 2-CE in 2026 and 2027. Check the current blueprint and bulletin of information for question counts and timings.
Marking and results
Level 1 is reported as pass or fail. On its Level 2-CE page NBOME says you usually get an email within two to six weeks of taking the exam to say your score is ready. Score release dates are published on NBOME's testing windows page.
Important dates
Testing windows and score release dates are published by NBOME on its testing windows page, so check it for the current cycle. Test dates can generally be booked up to six months ahead. Candidates are advised to schedule at least 120 days before the date they want.
Fees
Exam fees are listed by NBOME for each level. For changes to a booking, the rules as listed on the official site in 2026 are as follows (US dollars):
More than 30 days before the test: reschedule or cancel online at no charge, with a full refund on cancellation.
6 to 30 days before: 170 for Level 3.
1 to 5 days before: 350 for Level 3.
Within 24 hours: counted as a no-show, with 500 for Level 3.
How to apply
Create an online account with NBOME and accept its terms and conditions.
Get approved as eligible by your COM, or by your residency programme director for Level 3.
Schedule a test date. Dates can generally be booked up to six months ahead. Level 1 and Level 2-CE cannot be booked fewer than 5 calendar days before the exam. Level 3 has its own registration deadline for each testing window.
Test accommodations can be requested through NBOME.
Preparation tips
Read the COMLEX-USA blueprint to see how content is weighted across competencies and clinical presentations.
Use NBOME's practice resources and the description of what to expect on exam day.
Plan the booking early, since the fee penalties for changing dates rise sharply close to the test day.
Can I retake COMLEX-USA after passing to improve my result?
No. A retake is only allowed to replace a failed attempt.
How many attempts do I get?
Four scored attempts per level, and no more than four attempts within any 12 months.