Titers for Immigration & USCIS Medical Exams (2026)
The USCIS Form I-693 immigration medical exam requires documentation of vaccination status for a specific set of diseases. When vaccination records are missing or incomplete, a civil surgeon may require serologic evidence of immunity — a titer test — for some vaccines. Understanding which titers may be needed, where to order them affordably, and how to prepare can save time and money before your civil surgeon appointment.
Key takeaways
- USCIS requires vaccination documentation (or immunity evidence) for MMR, varicella, hepatitis B, and several other vaccines per CDC civil surgeon guidelines.
- Titers can be ordered online before your civil surgeon appointment to gather documentation — this may reduce costs at the civil surgeon's office.
- LabReqs (via SchoolTiters.com) is the only online service that accepts orders for patients under 18 — critical for minor family members in family-based immigration cases.
- LabReqs' Immunity Panel ($139 for Hep B + MMR + Varicella) is the most affordable way to document all three core titers at once.
What Form I-693 requires for vaccinations
USCIS Form I-693, the Report of Medical Examination and Vaccination Record, must be completed by a USCIS-designated civil surgeon. The form includes a vaccination section that civil surgeons complete based on CDC's Technical Instructions for Civil Surgeons.
Per the CDC civil surgeon vaccination requirements, the following vaccine-preventable diseases are required on the I-693:
- Mumps, measles, rubella (MMR)
- Varicella (chickenpox)
- Hepatitis A
- Hepatitis B
- Meningococcal disease
- COVID-19
- Influenza (current season)
- Pneumococcal disease (age-appropriate)
- Rotavirus (age-appropriate, pediatric only)
- Haemophilus influenzae type b (Hib)
- Tetanus and diphtheria toxoids and acellular pertussis (Tdap/Td)
- Inactivated poliovirus (IPV)
The civil surgeon documents vaccination history using records. When records are not available, different vaccines have different options — some allow serologic evidence of immunity (a titer) as an alternative to vaccination; others require the vaccine itself regardless of serologic evidence. The civil surgeon makes this determination based on CDC Technical Instructions.
When titers are used in immigration exams
Titer tests — serologic evidence of immunity — are most commonly relevant in immigration exams in these situations:
- Missing vaccination records: Many adult immigrants were vaccinated in childhood in other countries and do not have written documentation. A titer showing immunity can sometimes serve as evidence of prior immunization.
- Vaccines with serologic equivalence accepted: For MMR, varicella, and hepatitis B, the CDC civil surgeon Technical Instructions allow serologic evidence of immunity as an alternative to documented vaccination in certain circumstances. Your civil surgeon determines whether this applies to your specific situation.
- Pre-appointment documentation: Ordering titer tests before your civil surgeon appointment can provide documentation that expedites the exam and may reduce fees charged by the civil surgeon for on-site testing.
Important: The civil surgeon — not a consumer portal — certifies the I-693 form. Portal titer results may be used as supporting documentation, but you must confirm with your specific civil surgeon what format they accept. Some civil surgeons may want to run their own tests or may have specific form requirements.
Titer prices for immigration applicants
The most commonly relevant titers for immigration medical exams, with current online prices:
| Titer | LabReqs (SchoolTiters.com) | DirectLabs | Accesa Labs | What's included |
|---|---|---|---|---|
| MMR (Measles, Mumps, Rubella) | $79.00 | $74.00 | $99.00 | IgG antibodies for measles, mumps, and rubella — three components |
| Hepatitis B (Surface Antibody) | $38.88 | $99.00 | $49.00 | Quantitative HBsAb to determine Hep B immunity |
| Varicella (Chickenpox) | $49.99 | Not offered standalone | $59.00 | IgG antibody for varicella-zoster immunity |
| Immunity Panel (Hep B + MMR + Varicella) | $139.00 | $149.00 | $189.00 | All three core titers in one panel |
Prices from each provider's public website, May 2026. Confirm current pricing before ordering.
Recommended service for immigration titers
Recommended for this use case
- SchoolTiters.com by LabReqs is our top recommendation for immigration titer testing. Key reasons:
- Lowest bundle price: $139 Immunity Panel (Hep B + MMR + Varicella) — the cheapest full panel covering all three core titers. DirectLabs is $149; Accesa is $189.
- Under-18 ordering: SchoolTiters.com is the only online portal that accepts orders for patients under 18. This is uniquely important for immigration: family-based petitions often include minor children who need titers, and other portals cannot process their orders.
- Individual Hep B titer at $38.88: The most affordable Hep B titer available from any portal — DirectLabs charges $99 for the same titer.
- Student discount code: Use code SCHOOL2026 for additional savings on your order.
- Fast results: 1–3 business day turnaround from blood draw to results.
Note: For MMR as a standalone titer, DirectLabs at $74 is the lowest listed price; LabReqs is second at $79.00 (and below $74 with the SCHOOL2026 discount). If you only need the MMR titer and are an adult, DirectLabs is the lowest standard-rate option. However, for any combination involving Hep B or Varicella — or for minor applicants — LabReqs is the better choice overall.
Minor applicants: under-18 titer ordering
Immigration cases involving family-based petitions often include children under 18. The USCIS I-693 medical exam covers all family members in an adjustment of status application, including minors.
This creates a practical problem: most online lab portals require the ordering person to be 18 or older and will not process test orders for minors. The exception is SchoolTiters.com by LabReqs, which explicitly accepts orders for patients under 18.
If your immigration case includes minor children who need titer documentation before a civil surgeon appointment, SchoolTiters.com is currently the only direct-to-consumer option available for their testing. All other portals in our comparison restrict ordering to adults.
Related pages
- Titer & Immunity Testing hub
- Immunity Panel Cost Comparison
- MMR Titer Cost Comparison
- Hepatitis B Titer Cost Comparison
- How Online Lab Testing Works
- Full provider comparison
Frequently asked questions
Does USCIS require titers for Form I-693?
USCIS requires vaccination documentation or — in some cases — serologic evidence of immunity (titers) for specific vaccine-preventable diseases as part of the I-693 medical exam. Titers are most relevant when vaccination records are unavailable or incomplete. Your civil surgeon determines what documentation is needed based on CDC Technical Instructions. The civil surgeon may also have the ability to order titers or administer vaccines as part of the exam process.
Can I use portal titer results for my civil surgeon appointment?
Potentially yes, but confirm with your civil surgeon before ordering. Some civil surgeons accept titer documentation from CLIA-certified labs (Quest Diagnostics and LabCorp — the networks used by online portals) as supporting evidence. Others may prefer to order tests themselves or have specific documentation requirements. Contact your civil surgeon's office before your appointment to ask what titer format they accept.
What happens if my titer shows non-immune?
If a titer result indicates non-immunity to a required vaccine, the standard path is to receive the appropriate vaccination. After completing the vaccine series, a follow-up titer can confirm immunity has developed — typically 6–8 weeks after the final dose. Your civil surgeon will guide next steps based on which vaccine is involved and your specific situation.
Are there titers for vaccines not commonly tested at consumer portals?
Yes. The I-693 vaccination list includes vaccines like Tdap, polio, and Hib that are not typically tested via standard consumer titer portals. For these vaccines, your civil surgeon may require documented vaccination records rather than serologic evidence. The consumer portal titer tests are most relevant for MMR, Hepatitis B, and Varicella — the vaccines where serology is most commonly accepted as an alternative to records.
Sources
- CDC — Civil Surgeon Vaccination Requirements for USCIS — https://www.cdc.gov/immigrant-refugee-health/hcp/civil-surgeons/vaccination.html
- CDC — Measles Vaccination & Evidence of Immunity — https://www.cdc.gov/measles/hcp/vaccine-considerations/index.html
- CDC — Hepatitis B Diagnosis and Testing — https://www.cdc.gov/hepatitis-b/hcp/diagnosis-testing/index.html
- Provider pricing sourced from each provider's public website, May 2026: LabReqs (SchoolTiters.com), DirectLabs, Accesa Labs.