Comprehensive Osteopathic Medical Licensing Examination
COMLEX USA Exam Practice 2025
What is COMLEX Exam?
The Comprehensive Osteopathic Medical Licensing Examination of the United States 2025 (COMLEX USA) is a series of medical licensure examinations for osteopaths. It is designed to evaluate osteopathic medical expertise and clinical skills considered necessary for osteopathic general practitioners in the practice of osteopathy.
The COMLEX exam 2025 series follows a progressive series broken down into three levels: Level 1, Level 2 (CE/PE), and Level 3. It is administered continuously throughout the year by the National Board of Osteopathic Medical Examiners (NBOME) and is accepted in all the 50 states.
The COMLEX-USA concept is focused on the osteopathic theory of general health care, self-healing and self-regulatory processes, the basic structure-function relation as well as the interdependence of body systems, and the full extent of the osteopathic method to patient care, including osteopathic coercive treatment.
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COMLEX Format and Test Structure
As mentioned above, the COMLEX is a series of licensing examination broken into three levels:
COMLEX Level 1
A problem-and-symptom-based test, conducted in a time-based setting that combines fundamental biomedical sciences and other fields of medical knowledge related to the resolution of clinical issues and the promotion and preservation of health in the delivery of osteopathic medical treatment to patients.
Foundational Biomedical Sciences:
● Anatomy
● Behavioral Science
● Biochemistry
● Genetics
● Health Promotion and Disease Prevention
● Immunology
● Microbiology
● Osteopathic Principles and Practice
● Pathology
● Pharmacology
● Physiology
COMPLEX Level 1 Prep
Here are the best COMLEX Level 1 Prep resources:
1. COMBANK
2. Uworld
3. First Aid for Step 1
4. COMSAE and NBME practice exams
5. OMT Review by Savarese
| Subsection | No. of Questions | Description |
| 1 | 50 | Morning Session: 4 Hours Total Testing Time |
| 2 | 50 | |
| Authorized 10-minute break | ||
| 3 | 50 | |
| 4 | 50 | |
| Authorized 40-minute lunch break | ||
| 5 | 50 | Afternoon Session: 4 Hours Total Testing Time |
| 6 | 50 | |
| Authorized 10-minute break | ||
| 7 | 50 | |
| 8 | 50 | |
| Total | 400 | 8 hours |
Note: Questions can be answered, reviewed, and changed one subsection at a time. Individual subsections are not timed.
COMLEX Level 2
1. Cognitive Evaluation (CE) – a one-day computer-based test that combines the integration of expertise in clinical science and basic biomedical and osteopathic disciplines with other medical skills relevant to patient care and health promotion in regulated clinical settings.
Clinical Sciences Disciplines
● Emergency Medicine
● Family Medicine
● Health Promotion and Disease Prevention
● Internal Medicine
● Neurology
● Obstetrics/Gynecology
● Osteopathic Principles and Practice
● Pediatrics
● Psychiatry
● Surgery
| Subsection | No. of Questions | Description |
| 1 | 50 | Morning Session: 4 Hours Total Testing Time |
| 2 | 50 | |
| Authorized 10-minute break | ||
| 3 | 50 | |
| 4 | 50 | |
| Authorized 40-minute lunch break | ||
| 5 | 50 | Afternoon Session: 4 Hours Total Testing Time |
| 6 | 50 | |
| Authorized 10-minute break | ||
| 7 | 50 | |
| 8 | 50 | |
| Total | 400 | 8 hours |
Note: Questions can be answered, reviewed, and changed one subsection at a time. Individual subsections are not timed.
2. Performance Evaluation (PE) – a patient-based evaluation of the core clinical skills measured across 12 sessions with regular patients. The applicant must personally conduct the clinical skills of standardized clients in a timely, secure, effective, and safe way, as necessary.
Fundamental Clinical Skills Assessed
● Humanistic Domain
○ Physician-Patient Communication
○ Interpersonal skills
○ Professionalism
● Biomedical/Biomechanical Domain
○ Medical History-Taking and Physical Examination Skills
○ Osteopathic Principles and Osteopathic Manipulative Treatment (OMT)
○ Documentation Skills (including synthesis of clinical findings, integrated differential diagnosis, and formulation of a diagnostic and treatment plan)
| Section | Amount Per Segment | Length |
| Registration | — | 30 Minutes |
| Candidate Orientation | — | 50 Minutes |
| Standardized Patient (SP) Case Encounters | 4 Cases | 14 Minute Encounter with SP + 9 Minute eSOAP (Subjective Objective Assessment Plan format) completion per case |
| Lunch | 30 Minutes | |
| Standardized Patient Case Encounters | 4 Cases | 14 Minute Encounter with SP + 9 Minute eSOAP (Subjective Objective Assessment Plan format) completion per case |
| Break | 15 Minutes | |
| Standardized Patient Case Encounters | 4 Cases | 14 Minute Encounter with SP + 9 Minute eSOAP (Subjective Objective Assessment Plan format) completion per case |
| Closing Survey | — | — |
| Total | 12 cases | 194 minutes (3 hours and 14 minutes) |
COMLEX Level 3
A two-day computer-based assessment of competence in the field of basic competence needed for general practitioners to provide effective and safe osteopathic medical treatment and to improve health in unmonitored clinical settings.
| Subsection | Questions | Description | |
| Day 1 | 1 | 70 multiple-choice questions | Morning Session: 3.5 Hours Total Testing Time |
| Authorized 10-minute break | |||
| 2 | 70 multiple-choice questions | ||
| Authorized 40-minute lunch break | |||
| 3 | 70 multiple-choice questions | Afternoon Session: 3.5 Hours Total Testing Time | |
| Authorized 10-minute break | |||
| 4 | 70 multiple-choice questions | ||
| Day 2 | 5 | 13 clinical decision-making cases | Morning Session: 3.5 Hours Total Testing Time |
| Authorized 10-minute break | |||
| 6 | 13 clinical decision-making cases | ||
| Authorized 40-minute lunch break | |||
| 7 | 13 clinical decision-making cases | Afternoon Session: 3.5 Hours Total Testing Time | |
| Authorized 10-minute break | |||
| 8 | 13 clinical decision-making cases | ||
| Total | |||
Note: Questions can be answered, reviewed, and changed one subsection at a time. Individual subsections are not timed.
COMLEX Level 3 Prep
How to study for COMLEX Level 3? Here are the best resources to use:
1. First Aid and Step 2/Level 2 Review Books
2. OMM Review
3. Qbanks: Uworld and Comquest
4. Practice Exams
5. NBOME Resources
COMLEX Scoring System
Scoring for the COMLEX tests is determined by the number of questions answered correctly (raw COMPLEX scores), which is converted to a standard score for the sake of reporting the results and providing the pass-fail rating.
| COMLEX Level | COMLEX Passing Scores |
| COMLEX-USA Level 1 | 400 |
| COMLEX-USA Level 2-CE | 400 |
| COMLEX-USA Level 2-PE | Pass |
| COMLEX-USA Level 3 | 350 |
NBOME does not disclose percentile scores in the applicant’s score reports. When the evaluation process is finished, percentile scores are measured and can be obtained using the Percentile Conversion Tool.
To get your COMLEX score percentile, you must:
1. Open the Percentile Score Converter on the NBOME website.
2. Enter your 3-digit score into the respective field
3. Select the examination level being converted
4. Pick the date of the test using the drop-down menu
5. Click the ‘CONVERT’ button
6. The numbers appearing to the right will be the corresponding percentile scores.
Applicants will be notified via email once their scores have been posted. Applicants may view their pass/fail status and/or scores for any COMLEX test via the CRS portal on the NBOME website (Account Access Login could be found at the upper right corner of the homepage).
Score Reports are usually published to the applicant’s account under the “View Score Report” and the protected school site of the NBOME CRS portal.
| Level | COMLEX Score Release |
| Level 1 | Approximately 4 to 6 weeks from the date of examination administration. |
| Level 2-CE | Approximately 4 to 6 weeks from the date of examination administration. |
| Level 2-PE | Approximately 8 to 10 weeks from the date of examination administration. |
| Level 3 | Approximately 8 to 10 weeks from the completion of the examination. |
Note: After the initial score release, please see the score release schedule on the NBOME website.
COMLEX Registration and Fees
Before you can enroll for and schedule a COMLEX-USA test, you will have to create your personal NBOME login credentials-protected account in the NBOME Client Registration System (CRS) following the instructions sent to you via email. Once an account has been created, registrants may:
● Confirm examination eligibility & requirements
● Select & purchase examinations
● Change an existing examination date
● Manage payment & personal information
● Read & agree to the required terms & conditions for registration
To take a COMLEX-USA test, the name on your registration form and the valid government-issued photo ID shown at the test center must be the same. If the candidate’s name has changed, he/she must download and submit a name change request form along with a copy of the supporting document stating the name change (e.g. divorce decree, marriage license, naturalization document). Documents may be scanned and emailed to clientservices@nbome.org or faxed to 773-714-0606.
Note: Name changes should be made five business days prior to the test date. If applicable, submit the name-change request and the documents before applying for the test.
| COMLEX Cognitive Examinations | JULY 2025-JUNE 2025 | JULY 2025-JUNE 2025 |
| Level 1 | $660 | $675 |
| Level 2-CE | $660 | $660 |
| Level 2-PE | $1,295 | $1,300 |
| Level 3 | $875 | $890 |
Additional Fees
| Computer-based Exams | Level 1 | Level 2-CE | Level 3 | |
| Reschedule or Cancellation Fee | More than 30 days before the scheduled date | $0 | $0 | $0 |
| Reschedule or Cancellation Fee | 6 to 30 days before the scheduled date | $85 | $85 | $170 |
| Cancellation Fee | 1 to 5 days before the scheduled date | $190 | $190 | $290 |
| No Show Fee | Within 24 hours of the scheduled date | $225 | $225 | $340 |
| Computer-based Exams | Level 2-PE | |
| Reschedule or Cancellation Fee | More than 90 days before the scheduled date and time of the exam | $0 |
| Reschedule or Cancellation Fee | 15 to 90 days before the scheduled date and time of the exam | $50 |
| Reschedule or Cancellation Fee | 48 hours to 14 days before the scheduled date and time of the exam | $400 |
| Reschedule or Cancellation Fee | 24 to 48 hours before the scheduled date and time of the exam | $750 |
| Reschedule or Cancellation Fee | Within 24 hours of the scheduled date and time of the exam | $1295 |
Note: Examinations cannot be rescheduled later than 5 days before the scheduled date. Cancellations must be made online through the candidate’s NBOME account.
| Non-Examination Related | Level 1 | Level 2-CE | Level 2-PE |
| Score Confirmation Fee | $50 | $50 | $50 |
| Insufficient Funds Checking Fee | $20 | $20 | $20 |
| Transcript Fee | $60 | $60 | $60 |
| Score Report Fee | $5 | $5 |
COMLEX Prep Guide
1. Set a goal
Pick a score for each exam level that you think is attainable and set it as your goal. This will help keep you driven to study and work hard to meet and surpass your goal.
2. Start COMLEX study as soon as possible
The ideal preparation for the COMLEX is 8 to 12 months before you take the tests. If you’re studying for your first COMLEX, you have to make sure that you’re going to be as over-prepared as possible because not knowing what to expect could add some stress.
3. Do a minimum of 5 practice questions each day
In order to be adequately prepared for a test of 400 questions, you would need to review more than 400 questions. Doing at least 5 each day will enable you to absorb the amount of information you require. It is important to set up a study schedule, choose a starting date, and then stick to it.
4. Do not use too many resources to study
Limit your study resources to 1-2 online question banks and 1-2 books for additional study materials. This guarantees that you get the most from your study resources rather than stretching yourself thin and gaining very little from each study tool.
5. Take notes
Taking notes while reviewing helps imprint information into your brain more than memorization does.
6. Do at least one timed COMLEX practice exams
To feel totally prepared for the test date, you must take at least one timed, 400-question practice test to make you feel better about what answering the questions would be like on the test day.
COMLEX Prep course:
‥ Kaplan — Top Pick
‥ Wolf Pacc — Best Live Online Course
‥ Killexams — Most Affordable
‥ Med Learnity — Best Instructors
‥ PASS Program — Best Tutoring Program
‥ True Learn — Best Online Course
‥ National Board of Osteopathic Medical Examiners (NBOME) — Best Free Practice Exams
COMLEX Questions and Answers
COMLEX-USA Levels 1 and 2 need a minimum score of 400; COMLEX-USA Level 3 requires a minimum score of 350.
Candidates who fail an examination can retake it up to four times in a 12-month period.
In most cases, scores are available within 4–6 weeks of the exam date.
You must start practicing all exam components; this will help you improve your clinical thinking quickly on test day. Select and apply the resources that will help you in achieving your goal. Make a list of all your ideas and reasons for doing each and every thing on the PE.
Beginning May 1, 2025, the COMLEX Level 1 test will have a pass/fail system.
After graduating from their DO schools, candidates take the COMLEX Level 3 exam, generally before the completion of their Internship/first year of residency.
The COMLEX-USA Level 1, Level 2- Cognitive Evaluation (CE), and Level 3 3-digit standard scores range from 9 to 999, with a mean of 500. For the purposes of reporting results and delivering a pass/fail designation, the number of questions answered correctly (raw score) is converted to a standard score. Each test question counts equally to the candidate’s score, with the exception of pretest questions, which do not contribute to the candidate’s score.
The test is divided into two four-hour sessions, with a 40-minute break in between.
The test consists of four 3.5-hour computer-based test sessions split out over two days with two sessions each day.
The majority of students take 2-3 weeks to study for COMLEX Level 2.
Both types of OMM items should count up at least 25% of your whole COMLEX.
Each four-hour session is divided into four one-hour blocks with 50 questions, for a total of 400 questions.
The COMLEX-USA Level 2-CE has 352 multiple choice questions.
There are 352 questions in the COMLEX Level 1 exam.
The COMLEX Level 1 exam costs $675.
You must first create a personal NBOME password-protected online account in the NBOME Client Registration System before you can register for and schedule a COMLEX-USA examination. Confirm that you are eligible for the test and that you meet all of the requirements. Choose and purchase examinations. Change the date of an existing examination. Manage your payment and personal data. Read and agree to the registration terms and conditions.
If you need to reschedule, go to the Prometric website.
To do well on this test, you must know the basic scientific topics as well as osteopathic medicine. Make a study plan to figure out how many questions you’ll have to answer every day or how much information you’ll need to cover to meet your target. Take practice tests, they are essential for success on the COMLEX Level 1 exam. Choose two or three good resources and use them regularly. Before the exam, take care of yourself.
First, make a schedule for your studies. Select the best COMLEX level 2 CE materials. The key to succeeding on Level 2 or Step 2 is consistency; simply attempt to answer some questions and read something every day. Throughout each cycle, you must also read. Throughout the day is the best time to do this. It is important to be efficient.
The COMLEX is not as difficult as the USMLE. It isn’t necessarily easier, but it can be more complicated in some cases.
COMLEX stands for Comprehensive Osteopathic Medical Licensure Examination.
COMLEX-USA Level 1 is a problem-and-symptom-based assessment that integrates foundational biomedical sciences with other areas of medical knowledge relevant to solving clinical problems and promoting and maintaining health while providing osteopathic medical care to patients in a time-measured environment.
Bring your driver’s license or other government-issued ID with your complete name, as well as food and drinks.
In most cases, COMLEX Level 2 is completed in the third or fourth year of medical school.
During your second year of osteopathic medical school, take the COMLEX Level 1 test.
After passing the COMLEX Level 1 PE Exam, students will be able to take their COMLEX Level 2 PE Exam.