If you are applying for a Green Card through adjustment of status, the tuberculosis (TB) screening is one of the most critical—and strictly regulated—components of your immigration medical exam. The U.S. Centers for Disease Control and Prevention (CDC) and U.S. Citizenship and Immigration Services (USCIS) require a TB test for virtually all applicants age 2 and older, and the rules changed significantly in 2024. As of March 11, 2024, the CDC now mandates that civil surgeons use an interferon-gamma release assay (IGRA) blood test—not the traditional tuberculin skin test (TST)—for all applicants age 2 and older. Understanding these TB test requirements for immigrant visa medical exams is essential to avoid delays, unnecessary chest X-rays, or even a Class A inadmissibility finding that could derail your case. This guide walks you through who needs testing, which test is used, what happens if you test positive, and how to navigate the process smoothly.
Key Rule: As of March 11, 2024, all applicants age 2 and older must have an IGRA blood test (such as QuantiFERON-TB Gold or T-SPOT.TB) for tuberculosis screening. The tuberculin skin test (TST) is no longer accepted for applicants in this age group. If your IGRA is positive, or if you have signs or symptoms of TB disease or known HIV infection, a chest X-ray is required.
Who Must Undergo TB Testing for the Immigration Medical Exam?
TB screening is mandatory for nearly all green card applicants adjusting status from within the United States. The CDC's Technical Instructions for Civil Surgeons clearly define who must be tested and which test must be used.
All applicants age 2 and older must undergo an IGRA blood test as part of the immigration medical examination. This requirement applies regardless of your country of origin, prior BCG vaccination status, or whether you have ever had a TB test before. For children under 2 years of age, the civil surgeon must consult the CDC's Technical Instructions for specific guidance—testing may be indicated in certain circumstances.
The IGRA requirement is not optional. Civil surgeons cannot substitute a tuberculin skin test (TST) for applicants age 2 and older, even if the applicant requests it or has had a previous TST. The CDC made this change to improve accuracy and reduce false-positive results, particularly in individuals who have received the BCG vaccine.
IGRA vs. TST: Why the Skin Test Is No Longer Accepted
For decades, the tuberculin skin test (TST)—also known as the PPD test—was the standard method for TB screening in immigration exams. That changed on March 11, 2024, when the CDC updated its Technical Instructions for Civil Surgeons, mandating the IGRA blood test for all applicants age 2 and older.
The IGRA is a blood test that measures how your immune system responds to Mycobacterium tuberculosis antigens. It offers several advantages over the TST: it requires only one visit (no need to return 48–72 hours later to have the test read), it is not affected by prior BCG vaccination, and it has higher specificity, meaning fewer false-positive results.
The TST is now only permitted for children under 2 years of age when indicated. For all other applicants, the civil surgeon must use an FDA-approved IGRA test, such as QuantiFERON-TB Gold Plus or T-SPOT.TB.
| Feature | IGRA Blood Test | TST Skin Test |
|---|---|---|
| Status for immigration exams (age 2+) | ✅ Required | ❌ Not accepted |
| Number of visits | One visit (blood draw) | Two visits (application and reading) |
| Affected by BCG vaccine | No | Yes—can cause false positives |
| False-positive rate | Lower | Higher |
| Permitted for children under 2 | Yes, when indicated | Yes, when indicated |
What Happens If Your IGRA Test Is Positive?
A positive IGRA result does not mean you have active tuberculosis disease—it indicates that your immune system has been exposed to M. tuberculosis bacteria at some point. The civil surgeon must then take additional steps to determine whether you have infectious TB disease or latent TB infection (LTBI).
Under the CDC's Technical Instructions, all applicants with a positive IGRA must have a chest X-ray. The chest X-ray is used to look for signs of active TB disease in the lungs. If the X-ray is negative and you have no signs or symptoms of TB and no known HIV infection, you will be classified as Class B2 TB, Latent TB Infection. This classification does not make you inadmissible, but it is noted on your Form I-693 and reported to the health department.
If the chest X-ray shows abnormalities suggestive of infectious TB disease, or if you have signs or symptoms of TB or known HIV infection, the civil surgeon must refer you to the health department of jurisdiction for further evaluation, including sputum testing (smears and cultures). If active TB disease is confirmed, you will be classified as Class A TB—a condition that renders you inadmissible until you complete appropriate treatment.
What to Expect: Step-by-Step TB Screening Process
The TB screening is integrated into the broader immigration medical examination. Here is exactly what happens from start to finish.
- Medical history review: The civil surgeon will ask about any past TB diagnosis, prior treatment, symptoms (cough, fever, night sweats, weight loss), and any known exposure to TB. They will also ask about HIV status and immunosuppressive conditions.
- IGRA blood draw: For applicants age 2 and older, the civil surgeon will order an IGRA blood test. This is typically done at the same visit as other required lab tests (syphilis and gonorrhea screening). The blood sample is sent to a lab, and results are usually available within 2 to 7 days.
- Result review: If the IGRA is negative and you have no signs or symptoms of TB and no known HIV infection, no further TB testing is required. You receive a "No TB Classification."
- Chest X-ray (if IGRA positive, symptomatic, or HIV positive): If your IGRA is positive, or if you have signs or symptoms of TB disease or known HIV infection, the civil surgeon will order a chest X-ray. For applicants under 10 years of age, both anteroposterior and lateral views are required; for applicants 10 and older, a posteroanterior view is sufficient.
- Referral to health department (if indicated): If the chest X-ray is suggestive of infectious TB disease, or if you have signs or symptoms or known HIV infection, the civil surgeon must refer you to the health department of jurisdiction for sputum testing and further evaluation.
- Classification and documentation: The civil surgeon documents the TB classification on Form I-693. The options include: No TB Classification, Class B2 Latent TB Infection, Class B1 Pulmonary or Extrapulmonary TB, or Class A Infectious TB Disease.
Common Mistakes That Lead to Delays or Rejection
Even a straightforward TB screening can go wrong if you or the civil surgeon make errors. Below are the most frequent pitfalls to avoid.
- Assuming the skin test is still accepted. Many applicants and even some clinics are not aware that the TST is no longer accepted for applicants age 2 and older. If a civil surgeon administers a TST instead of an IGRA, the exam is not compliant with CDC instructions and must be redone.
- Failing to disclose prior positive TB tests or treatment. If you have a history of positive IGRA or TST results, or if you have been treated for LTBI or active TB in the past, tell the civil surgeon. This can affect the classification and may prevent unnecessary testing.
- Not bringing documentation of a prior positive IGRA. If you have written documentation of a previous positive IGRA from a physician, you do not need a repeat IGRA. Without that documentation, the civil surgeon must repeat the test.
- Ignoring symptoms. If you have a cough, fever, night sweats, or unexplained weight loss, do not hide it. These symptoms trigger a chest X-ray and possibly a referral—but hiding them can lead to a missed diagnosis and a much more serious problem later.
- Scheduling the exam too early or too late. The civil surgeon's signature on Form I-693 must be dated no more than 60 days before you file your Form I-485. If the TB screening process—especially sputum testing—takes longer than expected, you may miss this window.
Frequently Asked Questions
Q: Is the TB test required for all green card applicants?
A: Yes. All applicants age 2 and older must undergo an IGRA blood test for tuberculosis as part of the immigration medical examination. Children under 2 may also require testing in certain circumstances, as specified in the CDC's Technical Instructions.
Q: Can I use a TB skin test (TST) instead of the blood test?
A: No. As of March 11, 2024, the tuberculin skin test (TST) is no longer accepted for applicants age 2 and older. The IGRA blood test is now the required initial screening test for this age group.
Q: What happens if my IGRA test is positive?
A: A positive IGRA means you have been exposed to TB bacteria. You will be required to have a chest X-ray to check for signs of active TB disease. If the X-ray is negative and you have no symptoms, you will be classified as having latent TB infection (Class B2), which does not affect your admissibility.
Q: Will a positive TB test prevent me from getting a Green Card?
A: Not necessarily. Latent TB infection (LTBI) does not make you inadmissible. Only active, infectious TB disease (Class A) renders you inadmissible. If you are diagnosed with active TB, you must complete appropriate treatment before USCIS can approve your case.
Q: Do I need a chest X-ray if I have a negative IGRA?
A: Generally, no. A negative IGRA with no signs or symptoms of TB and no known HIV infection means no chest X-ray is required. However, if you have known HIV infection, you must have a chest X-ray and sputum testing regardless of your IGRA result.
Q: How long does it take to get IGRA results?
A: IGRA results are typically available within 2 to 7 business days. The civil surgeon cannot complete your Form I-693 until all lab results, including the IGRA, are received and reviewed.
Q: Is the COVID-19 vaccine still required for the medical exam in 2026?
A: No. As of January 2025, the COVID-19 vaccine is no longer required for immigration medical exams. This does not affect TB testing requirements.