When Is a Chest X-Ray Required for Immigration?

A chest X-ray is not a routine requirement for every immigration applicant. According to CDC technical instructions for immigration medical examinations, a chest X-ray is required in specific circumstances related to TB screening and clinical findings.

The primary trigger for a chest X-ray is a positive IGRA blood test result. If your TB blood test is positive, a chest X-ray is ordered to determine whether you have active TB disease or latent TB infection. The chest X-ray helps the civil surgeon assess whether there are any lung findings consistent with active TB.

Conditions That Require a Chest X-Ray

A chest X-ray will be ordered during your immigration medical exam if any of the following apply:

• Your IGRA (TB blood test) result is positive
• You have symptoms suggestive of TB disease (persistent cough, fever, night sweats, unexplained weight loss)
• You are 15 years of age or older and the civil surgeon determines it is clinically indicated
• You have a history of TB disease or prior TB treatment
• You have had known exposure to someone with active TB disease

What the Chest X-Ray Evaluates

The chest X-ray is reviewed by a radiologist and interpreted by the civil surgeon in the context of your TB test results and clinical history. The civil surgeon looks for findings that may indicate active TB disease, such as infiltrates (areas of infection in the lung tissue), cavities, enlarged lymph nodes in the chest, or pleural effusion (fluid around the lungs).

A normal chest X-ray in the setting of a positive TB blood test typically indicates latent TB infection — meaning TB bacteria are present but not causing active disease. This finding is documented on Form I-693 and generally does not prevent your immigration application from proceeding.

Chest X-Ray and Pregnancy

If you are pregnant and a chest X-ray is clinically indicated, the procedure can be performed safely with appropriate abdominal shielding to minimize radiation exposure to the fetus. Please inform our civil surgeon of your pregnancy before your examination begins so we can take appropriate precautions.

Cost and Billing for Chest X-Rays

The chest X-ray is not included in our flat-fee immigration medical exam pricing. If a chest X-ray is ordered, it will be billed separately. We will inform you before ordering the X-ray so you are aware of the additional cost. We can provide billing codes for insurance submission if applicable. Please contact our office if you have questions about pricing.