Key takeaways

Why is TB testing part of the immigration medical exam?

The immigration medical examination is designed to identify health-related conditions listed under U.S. immigration law, including certain communicable diseases of public health significance. Tuberculosis screening is therefore a required part of the examination performed by a USCIS-designated civil surgeon.

Under the current CDC Technical Instructions for Civil Surgeons, every applicant who is 2 years of age or older must receive an IGRA blood test. The IGRA measures how the immune system responds to proteins associated with tuberculosis bacteria.

For applicants younger than 2, routine IGRA testing is not automatically required. However, a child under 2 who has signs or symptoms suggesting TB disease or known HIV infection must receive additional testing, a chest X-ray, and health department evaluation according to CDC instructions.

What does a positive IGRA result mean?

A positive IGRA means that the applicant’s immune system reacted to tuberculosis antigens. It generally indicates infection with tuberculosis bacteria, but the blood test alone cannot determine whether the person has latent TB infection or active TB disease.

The next step is to evaluate the applicant’s medical history, symptoms, physical examination, and chest X-ray. In certain circumstances, sputum testing and further health department evaluation are also required.

What happens after a positive TB blood test?

Will I need a chest X-ray after a positive TB test?

Yes. Under the current CDC civil-surgeon requirements, a chest X-ray is required when an applicant has any of the following:

• A positive IGRA result
• Known HIV infection, regardless of the IGRA result
• Signs or symptoms suggesting tuberculosis disease, regardless of the IGRA result
• Extrapulmonary tuberculosis, regardless of the IGRA result

A chest X-ray is not automatically required for every immigration medical exam applicant. It becomes required when one of the CDC criteria applies.

Applicants age 10 or older generally receive a standard posteroanterior chest view. Children under age 10 who require a chest X-ray must receive an anteroposterior or posteroanterior view and a lateral view.

What different TB screening results may mean

What if my chest X-ray is normal?

If the IGRA is positive but the chest X-ray is not suggestive of infectious TB disease, and the applicant has no TB symptoms, no evidence of extrapulmonary TB, and no known HIV infection, the applicant will generally receive a Class B2 TB, Latent TB Infection classification.

This classification does not mean that the applicant has active or contagious tuberculosis. It means the applicant has evidence of TB infection without evidence of infectious disease at the time of the examination.

The civil surgeon must report the latent TB diagnosis to the health department with jurisdiction over the applicant’s location. This is generally a public health report rather than a referral for suspected active disease. The applicant is not automatically required to attend a health department appointment simply because the report is made.

Treatment for latent TB is still strongly encouraged because it can reduce the risk of developing active TB disease later. The civil surgeon may offer treatment or refer the applicant to another qualified healthcare provider.

What if the chest X-ray is abnormal?

An abnormal chest X-ray does not automatically confirm active tuberculosis. However, if the radiologist or civil surgeon identifies findings suggestive of infectious TB disease, the applicant must be referred to the local health department for additional evaluation.

Referral is also required when the applicant has signs or symptoms suggesting infectious TB disease or has known HIV infection, even if the IGRA or chest X-ray is negative.

Health department evaluation may include:

• Review of symptoms and medical history
• Review of the chest X-ray images and radiology report
• Three early-morning sputum specimens collected at least 24 hours apart
• Acid-fast bacilli smears and mycobacterial cultures
• Molecular testing when clinically appropriate
• Drug-susceptibility testing if a culture is positive for tuberculosis bacteria

During this process, the civil surgeon cannot issue TB medical clearance, sign the civil-surgeon certification, or finalize the applicant’s Form I-693. The applicant must return with documentation of the health department’s evaluation.

What happens if active tuberculosis is diagnosed?

An applicant diagnosed with infectious TB disease receives a Class A TB classification and cannot receive medical clearance until the required treatment has been successfully completed.

Treatment is generally managed by the health department or by a tuberculosis specialist working in coordination with the health department. Directly observed therapy may be required to confirm that the treatment regimen is taken correctly and completed.

After successful treatment, the health department completes the appropriate referral documentation. The applicant then returns to the civil surgeon, who reviews the records, updates the tuberculosis classification—generally to Class B0—and completes Form I-693 when all other medical examination requirements remain current.

Will a positive TB test delay my immigration medical exam?

A positive IGRA usually adds time because the applicant must complete a chest X-ray and the civil surgeon must review the radiology report. When the chest X-ray is not suggestive of infectious TB and there are no other concerning findings, the additional time may be limited to completing and reviewing the X-ray.

A longer delay may occur if the applicant requires health department referral and sputum cultures. CDC instructions require culture specimens to remain under observation for the applicable laboratory incubation period before final negative results can be issued. This process may take several weeks.

If infectious TB disease is diagnosed, the delay will generally continue through successful completion of the required treatment and final health department documentation.

Can the BCG vaccine cause a positive immigration TB blood test?

No. Many applicants born outside the United States received the Bacille Calmette-Guérin, or BCG, vaccine. BCG can sometimes affect a tuberculosis skin test, but it does not cause a false-positive IGRA blood test.

This is one reason TB blood testing is useful for applicants who received BCG. A prior BCG vaccination does not eliminate the immigration medical examination requirement and does not allow the civil surgeon to disregard a positive IGRA result.

What if I tested positive for TB in the past?

Tell the clinic before or during your appointment and bring every available record. An applicant with acceptable written documentation of a previous positive IGRA may not need another IGRA, but a chest X-ray is still required.

CDC instructions require documentation of a prior positive IGRA to include:

• The date the test was performed
• The type of IGRA used
• The numerical results in standard units of measurement
• The interpretation showing that the result was positive
• The testing physician’s name, signature, and office information

Documentation of a previous positive TB skin test does not replace the required IGRA for an applicant age 2 or older. An applicant who only has documentation of a positive skin test must still complete the IGRA required by the civil-surgeon instructions.

If you previously completed treatment for latent TB infection or TB disease, bring the diagnosis, medication names, treatment dates, completion record, prior chest X-ray reports, health department records, and any other supporting documentation.

An applicant with documented completed latent TB treatment, a chest X-ray that is not suggestive of infectious disease, no TB symptoms, and no known HIV infection may qualify for a finding of no Class A or Class B TB classification.

What if the IGRA result is indeterminate?

An indeterminate result is different from a positive result. It means the laboratory test did not produce a result that could be clearly interpreted as positive or negative.

For the immigration medical examination, the civil surgeon must document the indeterminate result. Under the current CDC Technical Instructions, an indeterminate IGRA does not by itself require the civil surgeon to repeat the test, order a chest X-ray, or assign a Class B2 classification.

The applicant may still be advised to pursue repeat testing with an appropriate healthcare provider for personal health reasons. A chest X-ray or health department evaluation may remain necessary when symptoms, known HIV infection, or other CDC criteria apply.

Does a positive TB test mean I failed the immigration medical exam?

No. The immigration medical examination is not a simple pass-or-fail physical. A positive IGRA is a screening result that determines what additional steps the civil surgeon must complete.

Most applicants with a positive IGRA do not have active TB disease. When the chest X-ray is not suggestive of infectious TB and no other concerning findings are present, the applicant can generally receive a Class B2 latent TB classification and complete Form I-693 without first completing latent TB treatment.

Infectious TB disease is different. It is a Class A condition that prevents medical clearance until successful treatment and required follow-up are completed. The civil surgeon documents the medical findings, while USCIS makes the final decision on the immigration benefit application.

What should I bring if I have a history of TB?

Records in another language may need a complete English translation. Contact the clinic before your appointment if you are unsure whether your records contain the details required under CDC instructions.

How to help prevent delays after a positive TB result

What happens to Form I-693 after TB follow-up is complete?

Once all required TB screening and any necessary referral evaluation are complete, the civil surgeon reviews the results and assigns the appropriate classification on Form I-693.

Applicants with uncomplicated Class B2 latent TB infection may generally have Form I-693 completed without finishing latent TB treatment. Applicants referred for possible infectious TB must wait until the health department provides the required evaluation documentation. Applicants diagnosed with infectious TB must successfully complete treatment before receiving medical clearance.

The civil surgeon will provide the completed Form I-693 in a sealed envelope for submission to USCIS and should provide a copy for the applicant’s records. Do not open or alter the sealed envelope. Follow the current USCIS instructions for submitting the form with the associated immigration benefit application.

Under USCIS policy effective June 11, 2025, a properly completed Form I-693 is generally valid only while the immigration benefit application or request with which it was submitted remains pending. If that application is denied or withdrawn, a new Form I-693 is generally required for a later application.

Frequently asked questions