COMLEX Level 2-CE Format and Blueprint

COMLEX Level 2-CE is a one-day, eight-hour exam: 320 single-best-answer questions in eight sections of 40, split across two separately timed four-hour sessions (NBOME exam format, NBOME Bulletin 2026-2027). It is not pass/fail. You get a three-digit score, and 400 passes (NBOME standard setting).

This page lays out the session structure, both dimensions of NBOME’s blueprint with their minimum percentages, how scoring and attempts work, and which practice forms copy the format.

By Dr. Sahith Valluru. For The Boards Professor, founded by Dr. Sean Moazezi, DO. Published and last updated October 28, 2026.

Exam format at a glance

Checked October 28, 2026. Rules change; the linked page is the authority.

Topic	Official rule	Source
Length	One day, eight hours: two separately timed four-hour sessions (A and B) of four sections each, 60 minutes of pooled break time and a 16-minute pre-exam information and tutorial.	NBOME Bulletin of Information 2026-2027
Questions	320 single-best-answer multiple-choice questions in eight sections of 40.	NBOME: COMLEX-USA examination format
Scoring	Three-digit standard score and a pass/fail designation, with a graphical performance profile.	NBOME: scoring and reporting
Passing score	400. The standard was last reviewed in February 2023, applied from June 2023, and is next due for review in February 2028.	NBOME: standard setting
First-time pass rate	92.5% of 9,096 first-time takers in the 2025-2026 testing cycle (June to May).	NBOME: examination performance data
Attempts	Four scored attempts per level in total, and no more than four attempts at a level in 12 months, counting incomplete and voided attempts. One final attempt beyond four only at the request of a medical licensing agency.	NBOME Bulletin of Information 2026-2027
Fee	$745.	NBOME: frequently asked questions
Results	Generally two to six weeks after the end of a testing window. Interim percentile scores are made available in September for Level 2-CE, to line up with ERAS.	NBOME: scoring and reporting

How the Level 2-CE day is built

Source: NBOME Bulletin of Information 2026-2027 and examination format page.

Part of the day	What happens
Pre-exam information and tutorial	16 minutes
Session A	Four hours, four sections of 40 questions
Pooled break time	60 minutes in total, used between sections as you choose
Session B	Four hours, four sections of 40 questions

Each session is timed on its own, so time you save in Session A does not carry into Session B (NBOME Bulletin). The break time is pooled: you choose how to spread the 60 minutes across the day. Spending most of it between the two sessions gives you a real reset before Session B.

For pacing, NBOME’s own practice exam is a guide. It keeps COMSAE Phase 2 at 160 questions in four hours specifically to match Level 2-CE’s per-question timing (NBOME COMSAE format), which works out at 90 seconds a question.

Blueprint dimension 1: competency domains

Source: NBOME, COMLEX-USA Level 2-CE blueprint.

Competency domain	Minimum share
1. Osteopathic principles, practice and manipulative treatment	10%
2. Osteopathic patient care and procedural skills	30%
3. Application of knowledge for osteopathic medical practice	26%
3.1 Foundational biomedical sciences knowledge base	25%
4. Practice-based learning and improvement	7%
5. Interpersonal and communication skills	5%
6. Professionalism	7%
7. Systems-based practice	5%

Patient care is the largest single domain at a minimum of 30%, which is why Level 2-CE questions so often ask for the next step rather than the diagnosis (NBOME Level 2-CE). OMM has a floor of 10%. Add up the seven domain minimums and you get 90%, so the blueprint leaves part of each form unassigned.

Blueprint dimension 2: clinical presentations

Source: NBOME, COMLEX-USA Level 2-CE blueprint.

Clinical presentation	Minimum share
Community health and presentations related to wellness	12%
Human development, reproduction and sexuality	5%
Endocrine system and metabolism	5%
Nervous system and mental health	10%
Musculoskeletal system	13%
Genitourinary/renal system and breasts	5%
Gastrointestinal system and nutritional health	10%
Circulatory and hematologic systems	10%
Respiratory system	10%
Integumentary system	5%

Musculoskeletal is the largest presentation at a 13% minimum, ahead of community health and wellness at 12%. Much of it overlaps with OMM, so the two are worth studying together. The ten minimums add up to 85%.

Scoring, passing and percentiles

Your report gives a three-digit standard score, a pass or fail designation and a graphical performance profile (NBOME scoring). The passing score of 400 was last reviewed in February 2023 and is next due for review in February 2028 (NBOME). Results generally arrive two to six weeks after your testing window closes, and NBOME releases interim percentile scores in September so programs have them for ERAS (NBOME).

Most first-time takers pass: 92.5% of 9,096 in the 2025-2026 testing cycle (NBOME performance data). For what a given score means against other takers, see our COMLEX score percentiles page.

Eligibility, fees and attempts

To register you need a Level 1 pass, completion of your second year at an accredited college of osteopathic medicine and a good-standing attestation from your dean (NBOME Bulletin). The exam fee is $745 (NBOME).

You have four scored attempts at Level 2-CE in total, and you cannot sit it more than four times in 12 months; incomplete and voided attempts count. A fifth attempt is possible only at the explicit request of a medical licensing agency (NBOME Bulletin 2026-2027). If a first attempt goes wrong, our failed COMLEX guide covers the retake.

Practice that matches the format

NBOME’s COMSAE Phase 2 is built for Level 2-CE: 160 questions in four sections of 40 at the same per-question pace, $60 a form (NBOME COMSAE). Take it in timed mode if you want a readiness check. Our COMSAE guide explains the forms and how to read their scores.

Format practice is also stamina practice. At least once before the exam, sit eight timed sections of 40 from your question bank in one day, with your breaks planned the way you will take them. If accuracy falls in Session B, the fix is pacing and endurance, not more content.

Level 2-CE and Step 2 CK side by side

Many DO students take both. The content overlaps, but the formats and scales do not: Level 2-CE is 320 questions in two four-hour sessions with a passing score of 400 and a minimum 10% OMM, while Step 2 CK has its own blueprint and passes at 218. Our Level 2-CE vs Step 2 CK comparison covers the differences in detail.