Cost structure and procedure, from the agency
The USCIS Medical Exam: What Sets the Cost and Why the Envelope Stays Sealed
The examination fee is set by the civil surgeon, not by USCIS, which is why quotes differ between clinics in the same city. USCIS requires that the civil surgeon give you a completed Form I-693 signed and placed in a sealed envelope. If you file Form I-485 by mail, that envelope stays sealed and goes with your package. If you file online, USCIS instructs you to open it and upload the form, then keep the original and the envelope until a final decision is made.
What this page recommends
Confirm the clinician is a designated civil surgeon using the official USCIS locator before booking, and ask the clinic to itemise the examination fee separately from vaccinations and any laboratory work.
Short answer
The examination fee is set by the civil surgeon, not by USCIS, which is why quotes differ between clinics in the same city. USCIS requires that the civil surgeon give you a completed Form I-693 signed and placed in a sealed envelope. If you file Form I-485 by mail, that envelope stays sealed and goes with your package. If you file online, USCIS instructs you to open it and upload the form, then keep the original and the envelope until a final decision is made.
Why two clinics quote different amounts
The immigration medical examination is performed by a civil surgeon designated for that purpose, and the fee for the examination is the clinic's, not a government charge. That single fact explains most of the confusion around cost: people expect a fixed federal price and find a range.
The examination fee is also not the whole bill. Vaccinations required to complete the vaccination record are a separate cost, and how many you need depends on what you can document having already received. Laboratory work may be separate again. A clinic that quotes one number without saying which of these it covers is not necessarily being evasive, but the quote cannot be compared to another clinic's until it is broken out.
This publication does not publish a price range for the examination, because it has not surveyed civil surgeon fees and a range invented for the sake of completeness would be worse than none. Call two designated civil surgeons and ask them to itemise.
What to ask a clinic to itemise
Ask for each line separately. This is the only way two quotes become comparable.
| Line item | Why it varies | What to ask |
|---|---|---|
| Examination fee | Set by the civil surgeon, not by USCIS | What is the fee for the examination alone? |
| Vaccinations | Depends on which you can document having already received | Which vaccinations will I need given my records, and what does each cost? |
| Laboratory work | May be billed by the clinic or by an outside laboratory | Is laboratory work included, and who bills me for it? |
| Follow-up visit | Sometimes required to complete the record | Is a second visit likely, and is it charged separately? |
| Records review | Bringing documentation can reduce what has to be repeated | What records should I bring so nothing is repeated unnecessarily? |
| Replacement form | If a form is lost or an envelope is opened improperly | What happens, and what does it cost, if the form has to be reissued? |
The sealed envelope rule, step by step
This is the procedural detail that most often goes wrong, and USCIS publishes it directly.
- The civil surgeon completes and signs Form I-693 and places it in a sealed envelope.
- USCIS states you must submit Form I-693 when you file Form I-485.
- If you file Form I-485 by mail, the envelope stays sealed and goes in the application package.
- If you file Form I-485 online, USCIS instructs you to open the sealed envelope and upload the completed form with your package.
- In the online case, keep the original form and the envelope until USCIS makes a final decision on the I-485.
- USCIS may review the original, or ask you to submit it as evidence, including at an interview.
- Confirm the clinician is a designated civil surgeon before the appointment, using the official locator.
Where the requirement itself comes from
The examination is not a clinic policy or a USCIS preference. The requirement sits in federal regulation, and the text is publicly readable in the Electronic Code of Federal Regulations at 8 CFR part 232. Reading the regulation is not necessary for most applicants, but knowing it exists is useful when someone offers a shortcut around it.
Forms, editions and procedures change, sometimes between one filing and the next. The USCIS page for Form I-693 is the authoritative place to check the current edition and the current instructions, and it is linked below. Nothing on this page should be relied on in place of it.
Sources
The agency and regulatory sources behind this page:
- Report of Immigration Medical Examination and Vaccination Record — U.S. Citizenship and Immigration Services. The sealed-envelope requirement, the online and mail filing difference, and the instruction to retain the original.
- Find a Civil Surgeon — U.S. Citizenship and Immigration Services. The official way to confirm a clinician is a designated civil surgeon.
- eCFR :: 8 CFR 232.1 -- General — Office of the Federal Register. The federal regulation that establishes the examination requirement.
These are independent sources. They are not affiliated with this publication and nothing was paid for their inclusion. Requirements change; confirm the current text at the source before relying on it.
Related resources
Affiliated educational resources on this subject:
- USCIS medical exam costs and timeframes — A longer educational guide to cost structure and timing. Affiliated / approved target.
- USCIS medical exam guides — General preparation guides for the immigration medical examination. Affiliated / approved target.
Questions people ask about the immigration medical examination
Does USCIS set the price of the exam?
No. The examination fee is charged by the civil surgeon, which is why clinics in the same city quote different amounts. Ask for the examination fee separately from vaccinations and laboratory work.
Can I open the sealed envelope?
It depends on how you file. USCIS instructs online filers to open the envelope and upload the completed form, keeping the original and envelope until a final decision. For a mailed Form I-485, the envelope goes in sealed. Follow the current USCIS instructions for your filing method.
How do I know a doctor is a civil surgeon?
Use the official USCIS civil surgeon locator. A clinic describing itself as an immigration exam provider is not the same as being designated, and the locator is the authoritative check.
Why does this page not give a price?
Because this publication has not surveyed civil surgeon fees and will not print a number it cannot support. The itemisation table above is designed to get a real quote from two clinics instead.
Editorial boundary
This page describes published agency procedure and links to it. It is educational only, is not immigration or medical advice, and cannot tell any individual what their case requires.
This page is informational. It is not legal, medical, mental-health, immigration, financial, or professional advice.