USMLE Step 1 Registration: Cost & Scheduling [2026]

Registering for USMLE Step 1 involves multiple portals, fees, and timelines depending on whether you're a US medical student or an international medical graduate (IMG). The process changed in recent years with the introduction of the MyIntealth portal for IMGs and the FSMB USMLE portal for exam scheduling.

This guide walks through every step — from eligibility verification to scheduling your Prometric test date.

Key Takeaways

• The base exam fee is $695. IMGs testing outside the US/Canada pay an additional $210 international surcharge (USMLE.org, 2026).
• US medical students register through their medical school's registrar and the FSMB USMLE portal.
• IMGs must complete ECFMG/MyIntealth credential verification before they can register for Step 1.
• You select a 3-month eligibility window when you apply, then schedule your specific test date through Prometric.

Who Is Eligible to Take Step 1?

US MD Students (LCME-Accredited Schools)

If you're enrolled in an LCME-accredited medical school in the US or Canada, you're eligible for Step 1. Your school's registrar typically initiates the registration process and certifies your enrollment status. Most schools allow Step 1 registration after completing your preclinical curriculum.

US DO Students (COCA-Accredited Schools)

DO students at COCA-accredited schools can register for USMLE Step 1 in addition to (or instead of) COMLEX-USA Level 1. The process is the same as for MD students — your school certifies your eligibility.

International Medical Graduates (IMGs)

You must meet all of the following criteria:

• Be a student or graduate of a medical school listed in the World Directory of Medical Schools (WDMS).
• Have completed (or be enrolled in) the basic medical sciences portion of your curriculum.
• Complete ECFMG eligibility verification through the MyIntealth portal before registering for the exam.

Your medical school must also meet ECFMG's specific requirements, including having its accreditation status verified in the WDMS.

Step-by-Step Registration Process

For US Medical Students

1. Contact your registrar. Your school's academic office initiates the USMLE registration process and certifies your enrollment.
2. Create a USMLE/FSMB account. Go to usmle.fsmb.org and create your account.
3. Submit your application. Select Step 1, choose your 3-month eligibility period, and select your testing region.
4. Pay the exam fee. $695 for US/Canada testing.
5. Receive your Scheduling Permit. This arrives via email and contains your CIN (Candidate Identification Number).
6. Schedule at Prometric. Use your CIN at prometric.com to book your exam date and location.

For International Medical Graduates

IMGs have additional steps before they can access the FSMB portal:

1. Create a MyIntealth account. Go to myintealth.org and set up your profile. Fee: $110.
2. Apply for ECFMG Certification. Submit your application and pay the certification fee: $580.
3. Complete credential verification. Provide your medical school transcripts and diploma for verification. Fee: $220.
4. Complete identity verification. Use NotaryCam or an equivalent service to verify your identity online.
5. Wait for ECFMG approval. Credential verification can take 2–12 weeks depending on your medical school's responsiveness.
6. Register through FSMB. Once ECFMG approves your eligibility, create your FSMB USMLE account and submit your Step 1 application.
7. Select your eligibility period and testing region. If testing outside the US/Canada, pay the $210 international surcharge.
8. Schedule at Prometric. Same process as US students.

2026 Fee Breakdown

Additional IMG-Specific Fees

Note: These fees are approximate and may change. Always verify current fees on USMLE.org and ECFMG.org.

How to Choose Your Eligibility Period

When you submit your application, you select a 3-month eligibility window during which you must sit for the exam. Choose carefully:

• Buffer time: Leave at least 2 weeks of buffer after your planned exam date. If you get sick or need to reschedule, you need time within your eligibility window.
• Prometric availability: Popular testing centers (especially international ones) fill up quickly. If you're testing in a major city, book as soon as you receive your Scheduling Permit.
• Extension requests: You can request a one-time, 3-month extension for $80, but it's not guaranteed. Don't rely on this.

How to Schedule Your Prometric Appointment

Once you receive your Scheduling Permit:

1. Go to Prometric.com/USMLE.
2. Enter your CIN and the exam code from your permit.
3. Search available testing centers by location.
4. Select your date and time slot (morning sessions begin at 8:00 AM).
5. Confirm and save your confirmation number.

Tips:

• Schedule as early as possible. Peak testing months (April–June for US MD students) fill up fast.
• If your preferred center is full, check nearby cities — driving an hour to a less crowded center beats delaying your exam by weeks.
• You can reschedule without a fee if you do it more than 30 days before your test date. Within 30 days, fees apply.

For what to expect on test day, read our USMLE Step 1 Prometric Test Day Guide.

Timeline Planning

For detailed study schedule guidance, see our USMLE Step 1 Study Plan.

What If You Need to Reschedule?

A failed "no-show" (not appearing on your test date without rescheduling) counts as a used attempt and forfeits your exam fee.

Frequently Asked Questions

How much does USMLE Step 1 cost?

The base exam fee is $695 for US/Canada testing. IMGs testing internationally pay $905 ($695 + $210 surcharge). Total IMG costs including ECFMG fees are approximately $1,815.

How long does ECFMG verification take?

Credential verification typically takes 2–12 weeks, depending on how quickly your medical school responds to ECFMG's requests. Some schools take months. Start this process early.

Can I take Step 1 while still in medical school?

Yes. US MD and DO students typically take Step 1 during or after their preclinical curriculum. IMGs can take Step 1 while still enrolled in medical school, as long as they've completed the basic science portion and have ECFMG eligibility.

How do I pick a testing location?

Search Prometric's site for centers near you. In the US, most major cities have multiple Prometric locations. Internationally, availability varies widely — some countries have only 1–2 centers. Book early.

Can I take Step 1 outside the US?

Yes. Prometric has testing centers in over 80 countries. The $210 international surcharge applies. Availability and scheduling flexibility are more limited than US centers.

What happens if I miss my eligibility window?

If your 3-month eligibility period expires without you sitting for the exam, your application and fee are forfeited. You must reapply and pay again.