- Practical grading weights: Basic Examination 35%, Surface Anatomy 20%, Mobilization Techniques 30%, HVMT 15%.
- Written exam is 2 hours, closed-book, equally weighted multiple-choice, delivered via Disamina.
- Combined written + practical fee is $450; retakes are $150 each; reschedules cost $50.
- You must score at least 70% on each component and 70% overall, with the practical double-weighted.
Quick Facts Snapshot
If you only have five minutes before your Certification in Orthopedic Manual Therapy (COMT) exam, this is the page to keep open. It compresses the issuer's own structure - IAOM-US's official COMT program - into the numbers, formats, and rules you actually get tested on. Nothing here is estimated; every figure traces back to the certification page and the practical rubric IAOM-US publishes. For a deeper walkthrough of any single item, this cheat sheet links out to the full COMT Study Guide and companion pages.
| Item | Detail |
|---|---|
| Combined written + practical fee | $450 (excludes coursework and membership) |
| Written retake fee | $150 |
| Practical retake fee | $150 |
| Schedule-change fee | $50 |
| Written exam length | 2 hours |
| Practical exam length | ~45 minutes |
| Written delivery platform | Disamina, remote |
| Practical delivery | Zoom or in person |
| Passing threshold | 70% each component and 70% overall (practical double-weighted) |
The Four Practical Domains at a Glance
The COMT practical exam is graded across four domains, and IAOM-US publishes the exact weighting for each. These percentages apply specifically to the practical examination - not to how written questions are allocated, since written prep instead follows the three body regions defined by your chosen coursework track. If you want the full breakdown of testable content inside each domain, see the COMT Exam Domains Guide.
Domain 1: Basic Examination (35%)
The heaviest-weighted domain. Evaluators watch your systematic approach to patient intake, observation, and baseline movement screening before any hands-on technique begins.
- Consistent, reproducible examination sequencing
- Clear rationale communicated for each screening step
Domain 2: Surface Anatomy (20%)
Tests your ability to locate and verbally identify anatomical landmarks accurately and efficiently on a live subject.
- Palpation precision on bony and soft-tissue landmarks
- Speed and confidence under live observation
Domain 3: Mobilization Techniques (30%)
The second-largest weight. Graders assess hand placement, grading of force, direction, and patient positioning across joint mobilization techniques.
- Correct grip and stabilization for each region tested
- Appropriate mobilization grade selection
Domain 4: High Velocity Manipulation Technique (15%)
The smallest weight but often the most anxiety-inducing domain because precision and safety are non-negotiable.
- Pre-manipulation positioning and safety checks
- Clean, controlled execution of the thrust technique
Key Takeaway
Because Basic Examination and Mobilization Techniques together account for 65% of the practical score, allocate proportionally more rehearsal time to those two domains than to Surface Anatomy or HVMT.
Written Exam Format
The written component is a 2-hour, closed-book test made up of single-correct-answer multiple-choice questions, and every question carries equal weight - there's no domain-based scoring breakdown to game on the written side. Instead, your preparation should map to the three body regions covered by your qualifying coursework, since that's how the written content is organized for each candidate.
The written exam is delivered remotely through the Disamina platform, which comes with its own set of technical requirements (covered below). Because there is no partial credit weighting by topic, treat every question as equally important and avoid spending disproportionate time on any single subject area during review. For strategies specific to this closed-book, single-attempt format, the COMT Study Guide walks through pacing and elimination techniques in more detail.
Fees & Registration Mechanics
Budgeting for COMT means separating three cost buckets: current IAOM-US membership, qualifying coursework in three body regions, and the exam fee itself. The combined written and practical examination fee is $450, and that figure does not include membership dues or coursework tuition. If you need to retake either component, each retake costs $150. Need to move your scheduled date instead? A reschedule costs $50.
Passing Score Math
Passing COMT requires clearing three thresholds simultaneously: at least 70% on the written exam, at least 70% on the practical exam, and at least 70% overall. The overall calculation is not a simple average - the practical score is double-weighted in the combined result, meaning practical performance carries more mathematical influence over your final outcome than the written score does.
Practically, this means a borderline written score can still be rescued by a strong practical performance, but the reverse is riskier: a weak practical score is harder to offset because of its double weighting. For the exact formula and worked examples, see COMT Passing Score: Exactly What You Need to Pass.
Key Takeaway
Since the practical score is double-weighted, prioritize hands-on rehearsal time even if you feel more naturally confident with written multiple-choice material.
Prerequisites Recap
Before you can sit for COMT, you need three things in place:
- Current IAOM-US membership
- A current physical-therapist or occupational-therapist license
- Qualifying coursework completed in any three body regions
Coursework can be completed through a hybrid pathway (8 hours online plus 14.5 hours hands-on per region), or through CSI/NEXT and other approved combined pathways described by IAOM-US. Candidates should confirm which pathway aligns with their scheduling and learning preferences before committing to a region sequence, since the written exam content follows whichever three regions you complete. Full eligibility detail, including how the hybrid hour requirements stack across regions, is covered in the COMT Requirements guide.
Test-Day Technical Checklist
Both the written and practical exams have strict logistical requirements, and failing to meet them on test day can cost you the attempt entirely.
Written Exam (Disamina, Remote)
- Google Chrome browser required
- Active, functioning webcam
- A smartphone positioned to show a Zoom view behind you during the test
- A room check before the exam begins
- No books, manuals, notes, or electronic references permitted anywhere in the room
Practical Exam (Zoom or In Person)
- A suitable subject arranged in advance, with documented consent
- A camera assistant to help capture the exam from appropriate angles
- Required equipment on hand for the techniques being demonstrated
- Virtual candidates get 3 minutes of prep time; in-person candidates get up to 30 minutes
Final-Week Review Plan
Generic study techniques only matter if they're mapped to COMT's actual weighting. Here's how to use your last week before the exam, sequenced around the practical rubric's point values.
Basic Examination & Mobilization Techniques
- Drill examination sequencing until it's automatic (35% weight)
- Rehearse mobilization grip, grading, and positioning across all three of your coursework regions (30% weight)
Surface Anatomy & HVMT
- Speed-drill landmark identification on a partner (20% weight)
- Walk through HVMT safety checks and controlled execution slowly, then at exam pace (15% weight)
Written Review by Region
- Cycle through practice questions for each of your three body regions equally, since written questions are equally weighted
Logistics & Light Review
- Confirm Chrome, webcam, and phone setup for Disamina
- Confirm your practical subject, camera assistant, and equipment
For a longer-horizon study plan that starts well before exam week, see the full COMT Study Guide, and pair it with realistic practice questions on the main COMT practice test platform to simulate the written exam's timing and single-answer format.
Who Hires COMT Holders
Physical therapists and occupational therapists pursue COMT to formalize advanced orthopedic manual therapy skills recognized by clinics and employers that value hands-on assessment and treatment competency. Because the certification requires an active PT or OT license as a prerequisite, it functions as a post-licensure specialization rather than an entry credential. If you're weighing whether the investment of coursework hours and fees pays off for your career trajectory, the ROI analysis and salary guide dig into that question directly, and COMT Jobs covers where the credential shows up in job postings.
Key Takeaway
COMT is a manual-therapy specialization layered on top of an existing PT or OT license - not a standalone entry-level credential.
Frequently Asked Questions
They are practical-examination grading weights only: Basic Examination 35%, Surface Anatomy 20%, Mobilization Techniques 30%, and High Velocity Manipulation Technique 15%. Written questions are not allocated by these percentages.
Written preparation follows the three body regions defined by your qualifying coursework, rather than the four practical domains.
Each retake - written or practical - costs $150. A schedule change instead of a retake costs $50.
The practical score is double-weighted in the combined result, so it carries more influence on your overall outcome than the written score, though you must still clear 70% on each component individually.
Underestimating the technical setup - Chrome browser, webcam, and a smartphone Zoom view for written testing, or an unrehearsed subject and equipment setup for the practical, especially given the short 3-minute virtual prep window.
Keep this cheat sheet bookmarked alongside the full domains guide and the COMT difficulty breakdown, and run timed questions on the practice test platform as your exam date approaches.