COMLEX Percentiles 2025: A Complete Guide
The Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) serves as the primary licensure pathway for the nation's 157,000+ osteopathic physicians, with 92.6% of DO seniors successfully matching into residency programs in 2025—an all-time high that signals growing acceptance of osteopathic medical education. Understanding COMLEX percentiles has become increasingly critical, as this three-level examination series, administered by the National Board of Osteopathic Medical Examiners (NBOME), uniquely integrates osteopathic principles and manipulative treatment into its assessment framework. This distinguishes it from the allopathic USMLE while maintaining equivalent recognition by state medical boards and residency programs nationwide.
COMLEX-USA functions as a progressive assessment system designed to certify competence at critical stages of medical training. The examination series evaluates not only medical knowledge but also the distinctive osteopathic approach to patient care, with COMLEX score percentiles serving as key indicators for residency selection. Unlike USMLE, COMLEX includes 12-20% osteopathic manipulative treatment (OMT) content integrated across all clinical presentations, reflecting the holistic, body-as-a-unit philosophy central to osteopathic practice.
COMLEX Level 1 Pass/Fail Era
COMLEX Level 1, historically the gatekeeper examination taken at the end of the second year of medical school, underwent a seismic shift on May 10, 2022, eliminating numeric scoring in favor of pass/fail reporting. This change, mirroring the transition of USMLE Step 1, fundamentally altered residency application dynamics for DO students by removing COMLEX score percentiles from consideration for Level 1. The examination tests foundational biomedical sciences through 352 multiple-choice questions over eight hours, with 75% of content focused on basic science knowledge integrated with clinical problem-solving scenarios.
Before the transition, Level 1 scores ranged from 100 to 900, with a passing COMLEX score of 400 (approximately the 8th percentile) and a mean of approximately 500-550. The examination achieved a 92.2% first-time pass rate in the 2021-2022 academic year, although students now receive only a pass/fail designation, accompanied by formative performance profiles for self-assessment purposes. Without Level 1 COMLEX percentiles, the importance of Level 2 scores has dramatically increased as the primary numeric differentiator for residency applications, fundamentally reshaping study strategies and application approaches for osteopathic students.
The strategic implications extend beyond scoring changes. With Level 1 no longer providing a COMLEX score percentile for differentiation, 60% of DO students now take at least one USMLE examination in addition to COMLEX to maximize competitiveness for selective specialties. The examination will undergo further refinement in June 2026, reducing question count from 352 to 320 while maintaining the eight-hour testing window, part of NBOME's ongoing blueprint optimization efforts.
Recent changes also include the transition to Pearson VUE testing centers throughout 2023, which expanded testing availability and improved technological infrastructure, addressing longstanding accessibility concerns.
COMLEX Level 2 Score Percentiles
COMLEX Level 2-CE (Cognitive Evaluation) has assumed paramount importance in the Level 1 pass/fail era, serving as the primary numeric metric for residency selection, with a 92.5% passing rate in the 2023-2024 cycle. Understanding COMLEX Level 2-CE score percentiles is useful for medical students. This one-day exam—typically taken at the end of the third year or the beginning of the fourth—assesses clinical decision-making across major clinical areas using 352 questions (transitioning to 320 starting with the June 2026 test cycle). The passing score remains 400, the 5th percentile, with a national mean for Level 2 scores hovering around 530.
COMLEX Level 2 Score Percentile Table
| Score Range | Level 2 Score Percentile | Strategic Implications |
|---|---|---|
| 700+ | 96th+ | Outstanding; Top-tier programs across all specialties |
| 650-699 | 89th-96th | Excellent; Competitive for most specialties, including surgical |
| 600-649 | 76th-89th | Strong/Competitive; Good for most programs |
| 550-599 | 59th-76th | Above average; Suitable for many programs |
| 500-549 | 37th-58th | Average; Limited to less competitive programs |
| 450-499 | 17th-36th | Below average; Significant limitations |
| 400-449 | 5th-17th | Minimally passing; Very limited options |
What is a good Level 2 score?
A "good" COMLEX Level 2 score depends entirely on your specialty goals. For primary care specialties like family medicine, scores above 500-550 (37th-59th percentile) on Level 2 are generally considered adequate. For competitive specialties like dermatology or orthopedic surgery, you'll need COMLEX Level 2 scores above 650 (89th percentile or higher) to be seriously considered. The mean of 530 represents the 50th percentile, so anything above this is technically "above average."
How does your Level 2 score affect your residency match outcome?
COMLEX Level 2 scores serve as the primary numeric screening tool for residency programs in the Level 1 pass/fail era. Programs frequently use cutoffs for interview invitations, with matched applicants showing significantly higher scores than unmatched candidates across all specialties. For example, emergency medicine shows matched averages of 585 versus 466 for unmatched candidates—a 119-point difference in COMLEX Level 2 scores that can determine interview opportunities.
The 2025 match cycle demonstrated unprecedented success for DO applicants, with 92.6% of seniors matching—the highest rate ever recorded. Program director surveys reveal COMLEX Level 2 score percentiles rank as the fourth most important selection factor, behind specialty-specific letters, Level 1 exam pass, and clinical grades.
What are the recommended Level 2 scores for common and top residency programs?
Primary Care and Less Competitive Specialties:
Family Medicine: 526
Internal Medicine: 568
Pediatrics: 557
Psychiatry: 533
Moderately Competitive Specialties:
Emergency Medicine: 585
Anesthesiology: 617
Obstetrics/Gynecology: 601
Highly Competitive Specialties:
Orthopedic Surgery: 675
Dermatology: 681
Diagnostic Radiology: 661
Interventional Radiology: 664
Otolaryngology: 655
University of Colorado Internal Medicine explicitly requires minimum COMLEX scores of 600, representing rare transparency in published thresholds. Most programs employ a holistic review after initial Level 2 score screening, considering geographic ties, research productivity, clinical performance, and board scores.
COMLEX Level 3 Score Percentiles
COMLEX Level 3, typically taken during PGY-1 year of residency, presents unique characteristics within the examination series. Understanding COMLEX Level 3 score percentiles is important for licensure and fellowship applications, though less critical than Level 2 scores. With a passing score of 350—notably lower than the 400 required for Level 2—the COMLEX Level 3 examination maintains a remarkable 96.8% first-time pass rate for 2024. The current two-day format consists of 420 multiple-choice questions, plus 26 Clinical Decision-Making cases, although this will transition to a single-day examination in January 2027.
COMLEX Level 3 Score Percentile Table
| Score Range | Level 3 Score Percentile | Strategic Implications |
|---|---|---|
| 812+ | 95th+ | Exceptional; Demonstrates outstanding clinical knowledge; May benefit highly competitive fellowship applications |
| 750-799 | 88th-94th | Excellent; Top-tier performance; Advantageous for competitive fellowships that consider scores |
| 700-749 | 81th-88th | Very strong; Well above average; Unlikely to limit any fellowship opportunities |
| 650-699 | 70th-81th | Strong, solid performance; Comfortable margin above requirements for all programs |
| 600-649 | 57th-70th | Above average; Rarely impacts fellowship decisions |
| 550-599 | 43th-57th | Average; Focus fellowship selection more on clinical performance |
| 500-549 | 29th-43th | Below average; Adequate for licensure; Emphasize strong clinical evaluations for fellowships |
| 450-499 | 17th-29th | Low passing; May raise questions; Highlight residency achievements and research |
What is a good Level 3 score?
A "good" COMLEX Level 3 score is generally considered anything above 500, which places you comfortably above the passing threshold of 350. However, the strategic value of high Level 3 scores remains limited. Most fellowship programs simply verify passing status rather than using COMLEX Level 3 score percentiles for selection. A score above 650 demonstrates strong clinical knowledge, but you should focus on getting a clean pass (ideally on the first attempt), then invest in the levers that move interviews—clinical evaluations, letters, scholarly work, and specialty fit.
How does your Level 3 score affect your residency or fellowship?
For residency purposes, COMLEX Level 3 scores have minimal impact since most residents take the exam after matching. For fellowship applications, 56% of program directors report looking only for passing COMLEX Level 3 scores, while 27% don't consider them in interview decisions at all. Only 17% of programs maintain specific target COMLEX score percentiles, primarily in competitive subspecialties. The examination's primary function remains as a licensure qualification rather than competitive differentiation through Level 3 score percentiles.
State licensing requirements universally accept COMLEX Level 3, though timing constraints vary. Most states require passage within five years of Level 2-CE or before completing residency training. The upcoming format change to single-day testing addresses longstanding concerns about examination burden during busy residency schedules while maintaining a valid COMLEX assessment.
The Bottom Line
COMLEX-USA continues evolving to meet contemporary medical education needs while maintaining rigorous assessment standards for osteopathic physician licensure. The Level 1 pass/fail transition fundamentally reshaped application strategies, elevating COMLEX Level 2 score percentiles to primary importance for residency selection. With DO match rates at historic highs and growing program acceptance of COMLEX score equivalency, osteopathic students face expanding opportunities despite increased competition.
Strategic targeting based on specialty competitiveness, combined with holistic application development, provides the optimal pathway for success. Whether you're struggling with content mastery or aiming for elite program admissions, personalized COMLEX tutoring can make the critical difference in achieving your target scores.
MedBoardTutors offers expert COMLEX tutoring tailored to your individual needs and specialty goals. Our experienced tutors understand the unique challenges of osteopathic examinations and COMLEX score percentile requirements, providing personalized strategies to help you achieve a competitive Level 2 score and an optimal Level 3 score percentile. Schedule a free tutoring consultation today to discuss how we can help you achieve success in your osteopathic medical journey.