Why Laboratory Tests Are Required

USCIS requires specific laboratory tests as part of every Form I-693 immigration medical examination. These tests screen for communicable diseases of public health significance and are not optional — they must be completed and documented before the civil surgeon can certify Form I-693.

The required tests are the same for virtually all applicants, regardless of age or health history.

Which Lab Tests Are Required

The following laboratory tests are required for all adult applicants as part of the USCIS immigration medical examination.

• TB/IGRA blood test (QuantiFERON-TB Gold or T-SPOT.TB): screens for tuberculosis infection
• Syphilis serology (RPR or VDRL): screens for syphilis
• Gonorrhea test: required for applicants 15 years and older
• Chest X-ray: required if TB test is positive or clinically indicated

How Hidden Lab Fees Add Up

At clinics that use à la carte pricing, each laboratory test is billed as a separate line item. The TB/IGRA blood test alone can cost $80–$150 when billed separately. Syphilis and gonorrhea testing may add another $40–$80. If a chest X-ray is required, that can add $100–$200 more.

An exam advertised at $150 can easily reach $350–$450 or more once all required laboratory fees are added.

On-Site vs. Send-Out Laboratories

Some clinics perform laboratory tests on-site, which typically means faster results and better coordination with the civil surgeon. Other clinics send specimens to an outside laboratory, which can add processing time and may result in separate billing from the lab.

When evaluating a clinic, ask whether lab tests are performed on-site and whether the lab fees are included in the quoted price.

The Flat-Fee Alternative

A clinic that offers a true all-inclusive flat fee includes all required laboratory tests in the base price. You pay one amount and receive all required services — no separate lab bills, no surprise charges. When comparing clinics, always ask specifically whether lab fees are included in the quoted price.