TMOD is NBEO's ocular disease treatment exam, scored inside Part II and also offered alone for $630. California, Texas, Illinois and the District of Columbia require it for licensure, and New York, Hawaii and Indiana for therapeutic or legend drug certification. Oklahoma, Montana, Wisconsin and South Carolina accept alternatives in some cases.
TMOD, NBEO's Treatment and Management of Ocular Disease exam, measures what boards care about most when they let an optometrist prescribe: clinical decisions in diagnosing, treating and managing eye disease. Most optometrists pass it without noticing, because it sits inside Part II. It becomes a separate problem in two cases: a candidate passed Part II PAM but not the TMOD portion, or an experienced optometrist tested before TMOD was part of the standard series. Either one shows up the moment a new state asks for it.
How does TMOD relate to Part II?
NBEO's Part II PAM exam has 350 items, and about 120 of them are TMOD items. Candidates receive an overall PAM score and pass or fail decision plus a separate TMOD breakout score and its own pass or fail decision. NBEO describes TMOD as 120 items in a single session, "offered as a stand-alone examination or as an embedded portion of the PAM examination." Candidates registering for PAM do not register for TMOD separately. A candidate "who may have passed the overall PAM exam but did not pass the TMOD portion may elect to register for the stand-alone version of TMOD."
For exams given from August 2026, the stand-alone TMOD costs $630. Attempts count across both forms: under NBEO's six-time limit, an attempt on the embedded TMOD and an attempt on the stand-alone exam both count toward the same six.
Which states make TMOD a condition of licensure?
Many, in one of two ways. Some require it for any license. Others require it for the therapeutic certification that nearly every optometrist practicing today needs.
- California requires TMOD for every TPA and higher license type. Its FAQ answers an unlicensed applicant who did not pass TMOD with a plain "No."
- Texas requires TMOD passed on or after January 1985, for both its Acceptance Application and its License without Examination.
- New York requires TMOD for certification in therapeutic pharmaceutical agents, for graduates after Jan. 1, 1993.
- Indiana requires TMOD and ocular pharmacology education for its separate Optometric Legend Drug Certificate ($20), which is what lets an Indiana optometrist prescribe.
- Illinois wants an NBEO score report showing both written parts, including TMOD, and the clinical skills exam.
- The District of Columbia requires TMOD for both DPA and TPA authority.
- Hawaii requires TMOD for TPA certification, along with a 100-hour ocular disease course and a 100-hour preceptorship under an ophthalmologist.
- Pennsylvania requires TMOD for therapeutic licenses, and Rhode Island to use pharmaceutical agents.
- Minnesota makes every licensee meet its legend drug standards, which include TMOD.
Scope tiers carry different names in each state, which our post on TPA, orals and legend drug certificates sorts out.
Are there alternatives to passing TMOD?
A few boards accept something else, usually because the applicant trained before TMOD was standard:
- Oklahoma: a candidate who did not pass NBEO TMOD takes the Oklahoma State Board TMOD exam as part of the July State Board Exams.
- Montana: endorsement applicants may show TPA certification in place of TMOD.
- Wisconsin: TPA certification requires a 100-hour approved course and exam, or TMOD.
- South Carolina: endorsement applicants show the NBEO exam offered when they were first licensed, or a TMOD pass.
- Oregon: applicants who took TMOD before 2002 complete a board-approved AOT course first.
Outside those, assume the board wants the NBEO TMOD result itself, sent directly by NBEO.
When should an experienced optometrist take the stand-alone exam?
When the target state requires TMOD for the tier you practice at and offers no alternative that fits your history. Before registering, check three things. First, confirm the board's rule on when TMOD must have been passed; Texas, for example, accepts TMOD from January 1985 on. Second, count your attempts, since embedded and stand-alone attempts share one limit. Third, look at timing. NBEO generally posts computer-based exam scores about seven weeks after the administration ends, and the board cannot finish your file until it sees the result. If the state also gives an annual exam, as Oklahoma does, a late TMOD result can cost you that year's sitting.
NBEO sells a Part II PAM/TMOD practice databank through Test Run for $199 a month, open to candidates registered for the stand-alone TMOD as well; NBEO notes it "does not guarantee a passing score."
How does this show up in a readiness review?
The Optometry Licensing Readiness Review ($149) lists your NBEO parts with dates, including whether TMOD was embedded or stand-alone, against each state you are considering, and flags where a certification add-on is needed. Our Therapeutic, Glaucoma or Legend Drug Certification Add-On is $249 per certification, filed alongside the license. You register for and sit the exam yourself; we handle the paperwork around it. See pricing, which NBEO parts each state asks to see, or the state license index.
Common questions
- Do I need to register for TMOD separately from Part II?
- No. TMOD is embedded in Part II PAM and scored separately. You register for the stand-alone TMOD only if you passed PAM but not the TMOD portion.
- Does a failed embedded TMOD count as an attempt?
- Yes. NBEO counts attempts on the embedded and stand-alone TMOD toward the same six-attempt limit.
- Can I get licensed in California without TMOD?
- Not as a new California licensee. The board says TMOD is required for all TPA and higher license types, so an applicant who did not pass it must schedule the exam with NBEO.
- Is there any state where TMOD is not required?
- Some accept alternatives. Oklahoma gives its own TMOD exam with the July board exams, Montana accepts TPA certification for endorsement, and Wisconsin accepts a 100-hour course and exam for TPA.
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