# COMLEX Level 1, including the OMM material nobody else covers

> COMLEX-USA Level 1 practice generated from your own osteopathic material, 320 items since May 2026, with the principles slice built from your own OMM notes.

Markdown copy of https://meduniexam.com/exam/comlex-level-1 (the HTML page), published by MedUni Exam. Published September 12, 2026, updated September 22, 2026. Site guide for agents: https://meduniexam.com/llms.txt.

Osteopathic principles and manipulative treatment is 12 percent of Level 1, and it is the part MD oriented question banks serve worst. Your own OMM notes fix that, because this writes from the file you upload.

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## COMLEX Level 1 pass rate, fee, questions and score release dates

COMLEX Level 1 pass rate 2025-2026: 90.2 percent of 9,678 first time candidates, 87.2 percent of all 10,976. How many questions on COMLEX Level 1: 320 in 8 hours, two separately timed sessions of four hours, and the COMLEX Level 1 fee is USD 745. COMLEX Level 1 score release dates are scheduled dates set by the testing window, 12 to 30 days after it closes, with October 6, 2026 for the window ending September 23, 2026. Ten testing cycles of pass rates with the counts, and all twelve 2026-2027 score release dates, are in the post at /blog/comlex-level-1-pass-rate-and-score-release-dates.

| COMLEX Level 1 fact | Number | Applies to |
| --- | --- | --- |
| Questions and time | 320 single best answer questions in 8 hours, two sessions of 4 hours | 2026-2027 cycle, cut from 352 in spring 2026 |
| Sections and pace | 8 sections of 40 questions, 90 seconds a question | 2026-2027 cycle, pace computed from 28,800 seconds over 320 questions |
| Score release date | October 6, 2026, for the window ending September 23, 2026 | 2026-2027 cycle |
| Score release date | November 5, 2026, for the window ending October 23, 2026 | 2026-2027 cycle |
| Results wait | 12 to 30 days after the testing window closes, by 5:00 PM Central time | 2026-2027 cycle, counted from the NBOME schedule |
| Fee | USD 745 | Frozen at 2025 levels through the 2027-2028 cycles |
| Pass rate | 90.2 percent of 9,678 first time candidates; 87.2 percent of all 10,976 | 2025-2026 cycle |
| Pass rate | 90.3 percent of 9,381 first time candidates; 87.3 percent of all 10,533 | 2024-2025 cycle, new passing standard |
| Pass rate | 93.0 percent of 9,222 first time candidates; 90.9 percent of all 10,165 | 2023-2024 cycle |
| Passing score | Pass or fail only; the bulletin prints 400 as the Level 1 passing score | Pass or fail since May 10, 2022 |
| Attempts | 4 scored attempts, and no more than 4 in any 12 months | All COMLEX-USA levels |

Source: [NBOME COMLEX-USA examination performance data](https://www.nbome.org/assessments/comlex-usa/examination-performance-data/), [NBOME COMLEX-USA testing windows and score release dates](https://www.nbome.org/assessments/comlex-usa/testing-windows-score-release-dates/), [NBOME COMLEX-USA examination format](https://www.nbome.org/assessments/comlex-usa/examination-format/), [NBOME frequently asked questions](https://www.nbome.org/frequently-asked-questions/), [NBOME COMLEX-USA eligibility](https://www.nbome.org/assessments/comlex-usa/bulletin-of-information/eligibility/), [NBOME COMLEX-USA Level 1](https://www.nbome.org/assessments/comlex-usa/comlex-usa-level-1/), checked on September 22, 2026.

## The item count changed in May 2026, and so should your practice blocks

From the spring 2026 cycle the number of test items on Level 1 dropped from 352 to 320, aligned with the COMLEX-USA blueprint, and candidates still have eight hours. Any study material still saying 352 questions is out of date, including any practice plan you built on it. The blocks in the recipe below are sized on 320 items in eight hours.

The other reason this page exists: osteopathic principles, practice and manipulative treatment is 12 percent of Level 1, and osteopathic patient care and procedural skills another 6 percent. A bank written for MD students covers neither. Your own OMM notes do, and a generator writing from them produces items on the material your school actually taught, each one quoting the page.

## One question, as it arrives

A patient with chronic kidney disease develops severe muscle cramps and arrhythmias. Which electrolyte imbalance is most likely responsible for these symptoms?

1. **A.** Hyponatremia
2. **B.** Hyperkalemia correct answer
3. **C.** Hypocalcemia
4. **D.** Hyperphosphatemia
5. **E.** Hypomagnesemia

PAGE 982"Failure of K regulation can have serious consequences on nerve conduction, skeletal muscle function, and most significantly, on cardiac muscle contraction and rhythm."

double-checked

Written on September 15, 2026 on the free lane, job 248, question 13661, from [Anatomy and Physiology II (KCC), adapted from OpenStax Anatomy and Physiology](https://archive.org/details/cnx-org-col11907) (Jonathon Cohen, Kingsborough Community College, via the Internet Archive), page 982, published under the [Creative Commons Attribution 4.0](https://creativecommons.org/licenses/by/4.0/). The quote is the line the check found on that page, and a second model from a different family picked the same answer from the quote alone. Nothing here was edited by hand.

**54 percent of the questions drafted since counting began on September 14, 2026 failed a check and never reached a student.** Counted from this site's own database, as of September 24, 2026, refreshed twice an hour. A question fails when its quote is not on the page it cites, when a second model picks a different answer, when it breaks a writing rule or when it repeats one already written. [Each check, with its own rate](https://meduniexam.com/stats/rejections.md).

**Exam Pass, $19.99 once.** 90 days of the priority models for your COMLEX-USA Level 1 block, with the downloads and an unlimited tutor. Nothing renews. [Get the Exam Pass](https://meduniexam.com/#/pricing?buy=exam_pass) Start on the free plan first if you like: 300 verified questions a month with an account, 60 as a guest.

## A practice recipe for COMLEX-USA Level 1

Ask for 20 questions and set a 30 minute timer, the pace of 320 items in eight hours.

Paste this into the extra instructions box on the generate form, or let the button carry it there:

Write single best answer items with five options from the uploaded material. Where the source covers osteopathic principles or manipulative treatment, ask for the structural finding and the treatment that follows from it, in the same words the source uses. Elsewhere use a short clinical presentation and ask for the mechanism, the finding or the first step in management.

[Use this recipe in the generate form](https://meduniexam.com/#/?recipe=comlex-level-1)

The extra instructions box overrides the general guidance the model is given, so the wording above is followed on every question in the set.

## What this cannot do

- This is not an NBOME item pool and it has no connection to the NBOME. It writes items in that style from the file you upload.
- The osteopathic 18 percent is only covered if you upload your own OMM material. General preclinical notes will not produce it.
- Professionalism, communication and systems based practice carry about 8 percent between them and rarely appear in preclinical notes.
- The ten clinical presentation areas of the blueprint's second dimension are not weighted automatically. The set follows what is in your file.

## Format facts, and where each one comes from

- From the spring 2026 cycle the number of Level 1 test items dropped from 352 to 320, aligned with the COMLEX-USA blueprint, and candidates continue to have eight hours to complete the examination.Source: [https://www.nbome.org/news/enhancements-to-comlex-usa-exams-in-2026-2027/](https://www.nbome.org/news/enhancements-to-comlex-usa-exams-in-2026-2027/)
- Dimension 1 of the blueprint weights application of knowledge for osteopathic medical practice 60 percent, osteopathic principles, practice and manipulative treatment 12 percent, osteopathic patient care and procedural skills 6 percent, practice based learning and improvement 4 percent, interpersonal and communication skills 3 percent, professionalism 3 percent and systems based practice 2 percent.Source: [https://www.nbome.org/assessments/comlex-usa/comlex-usa-level-1/](https://www.nbome.org/assessments/comlex-usa/comlex-usa-level-1/)
- Dimension 2 is ten clinical presentation areas weighted 5 to 13 percent each, with musculoskeletal at 13 percent, community health and wellness at 12 percent and nervous system and mental health at 10 percent.Source: [https://www.nbome.org/assessments/comlex-usa/comlex-usa-level-1/](https://www.nbome.org/assessments/comlex-usa/comlex-usa-level-1/)
- A new break structure applies to candidates testing after May 7, 2026.Source: [https://www.nbome.org/news/enhancements-to-comlex-usa-exams-in-2026-2027/](https://www.nbome.org/news/enhancements-to-comlex-usa-exams-in-2026-2027/)

Format checked on September 12, 2026. These pages are reviewed once a quarter by the person who runs MedUni Exam, and the review is what moves the date above. If a number here is out of date, write to [support@meduniexam.com](mailto:support@meduniexam.com) and it gets fixed.

## What it costs in COMLEX-USA Level 1 units

With a free account the allowance is 300 verified questions a month, which in this exam's units is 15 runs of a 30 minute run of 20 questions, or about 94 percent of a full 320 item Level 1 exam, every month, at no cost. A guest workspace with no account gets 60 questions a month, which is 3 such runs.

The Exam Pass, $19.99 once, is one payment that puts the priority models on your jobs for 90 days and then stops on its own.

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Paid through Stripe, which shows the total before you pay. One payment, nothing renews, and the [refund policy](https://meduniexam.com/refund-policy.md) gives you 14 days, in full before you generate. A 500 question pack at $5.99 and the Pro subscription are on the [pricing page](https://meduniexam.com/pricing.md).

Works in any language, and quality varies by language: the questions come out in the language of your document, or in the one you pick from a list of every living language. [What works in your language, and what does not](https://meduniexam.com/for/any-language.md).

## Questions students ask

### Does it cover OMM?

It covers your OMM notes. Upload them as their own document and the questions come from those pages, with the line printed under each item.

### Is 352 or 320 the right number?

Three hundred and twenty, since May 2026. The source for that is linked in the format facts above.

### Can I use Step 1 material as well?

Yes, and most students do. The two exams overlap heavily on the biomedical sciences; the osteopathic slice is the part only your own material covers.

### Does it write the two answer osteopathic items?

It writes single best answer items with five options by default. Ask for a different type in the extra instructions and it follows your instruction where the source supports it.

[Upload a chapter](https://meduniexam.com/#/)

[How the checks work](https://meduniexam.com/how-it-works.md)

No account needed to try it. Registering keeps your library, grades and review queue across devices.

[All ten exams](https://meduniexam.com/exam.md) · [USMLE Step 1](https://meduniexam.com/exam/usmle-step-1.md) · [Real generated questions](https://meduniexam.com/sample.md)

## Related pages

- [COMLEX Level 1 Pass Rate Table and Score Dates](https://meduniexam.com/blog/comlex-level-1-pass-rate-and-score-release-dates.md): Ten testing cycles of NBOME pass rates for COMLEX-USA Level 1 with the counts behind them, all twelve score release dates of the 2026-2027 cycle with the wait counted in days, and the 320 item format the exam runs on.
- [USMLE Step 1 questions from your own file](https://meduniexam.com/exam/usmle-step-1.md): Step 1 style single best answer questions generated from a student's own pathology and physiology material, with the format facts and the limits stated.
- [USMLE Step 2 CK questions from your notes](https://meduniexam.com/exam/usmle-step-2-ck.md): Step 2 CK style management and diagnosis questions generated from a student's own clinical material, with the competency mix the blueprint actually uses.
- [For medical students](https://meduniexam.com/for/medical-students.md): Why questions generated from your own syllabus beat a generic question bank.
- [How Many Questions: Step 1, NCLEX, MCAT, PLAB](https://meduniexam.com/blog/how-many-questions-are-on-each-medical-exam.md): The question count, the testing time and the computed pace for the ten exams on this site, from USMLE Step 1 at about 280 questions to PLAB 1 at 180, each row naming the exam owner's document it came from, checked on September 21, 2026.