Every adjustment of status applicant runs into the same moment of sticker shock: they pay USCIS one filing fee for Form I-485, then find out their civil surgeon wants a separate check for Form I-693. It isn’t a billing error. The I-485 filing fee and the immigration medical exam are two different payments, to two different parties, for two different services — and understanding that split before you start filing saves a lot of confusion when the bills arrive.
What the I-485 Filing Fee Actually Includes
As of the current USCIS fee schedule (in effect since April 1, 2024), most applicants age 14 and older pay $1,440 to file Form I-485 on paper, or $1,390 if they file online where that option is available. Applicants under 14 who file together with a parent’s application pay a reduced $950; a child under 14 filing on their own still pays the full $1,440.
For most applicants, that fee already includes biometrics services — the fingerprinting and photo appointment USCIS uses for background and identity checks. You generally do not owe a separate biometrics fee on top of the I-485 filing fee. What that fee does not include is the medical examination itself.
Why the I-693 Medical Exam Is Billed Separately
Form I-693, Report of Immigration Medical Examination and Vaccination Record, has to be completed by a USCIS-designated civil surgeon — a licensed physician authorized to perform this specific type of exam. Civil surgeons are independent medical providers, not USCIS staff, so the government filing fee has no mechanism to pay them. You pay the civil surgeon’s office directly, the same way you’d pay for any other medical visit.
That fee typically runs somewhere between $200 and $500, and it can climb higher if you need vaccinations brought up to date as part of the visit, or if the clinic runs additional testing. Because civil surgeons set their own pricing, the amount varies by practice and by what your individual exam requires — which is exactly why it’s worth asking a clinic what its fee covers before you book.
The Full Cost Picture for Adjustment of Status
Put together, here’s what a typical I-485 filing involves on the cost side:
| Line item | Approximate cost | Paid to |
|---|---|---|
| I-485 filing fee (age 14+, paper filing) | $1,440 | USCIS |
| I-485 filing fee (online filing, where available) | $1,390 | USCIS |
| I-485 filing fee (under 14, filed with parent) | $950 | USCIS |
| Biometrics services | Included in filing fee | USCIS |
| I-693 medical exam | $200–$500+ (varies by clinic and required vaccines) | Civil surgeon |
The medical exam line is the one applicants most often forget to budget for, because it never appears on a USCIS fee receipt. It’s a private medical bill that happens to be a required part of your immigration filing, not a government fee at all.
Who Actually Qualifies for an I-485 Fee Waiver
USCIS does offer a fee waiver process, using Form I-912, Request for Fee Waiver. It is not, however, broadly available. Generally speaking, family-sponsored and employment-based adjustment applicants — the two largest categories of I-485 filers — do not qualify. The waiver is aimed at more specific categories, including VAWA self-petitioners, T visa holders, U visa holders, and certain special immigrant categories.
To be approved, an applicant typically has to show one of three things: household income at or below 150% of the Federal Poverty Guidelines, current receipt of a means-tested public benefit, or documented financial hardship. It’s also worth being clear-eyed about scope: an approved I-912 waiver covers the government filing fee. It does not extend to the civil surgeon’s bill for your I-693 exam, since that’s a private medical charge, not a USCIS fee.
Budgeting for Both Costs Before You File
Because the I-485 filing fee and the I-693 exam fee are separate transactions, the practical move is to treat them as two line items in your own planning from the start, rather than assuming one payment covers the whole process. A few things worth doing before your appointment:
- Confirm your civil surgeon’s exam fee up front, and ask specifically whether it includes any vaccines you’re likely to need — that’s usually where the total climbs.
- Bring your existing vaccination records if you have them. A complete record can mean fewer shots administered at the visit, which keeps the medical exam bill closer to the lower end of the typical range.
- Don’t wait until your I-485 is ready to submit to schedule the medical exam. Since it’s a separate appointment with a separate provider, booking it early avoids a last-minute scramble that can delay your filing.
- If you think you may qualify for a fee waiver, gather your income or benefit documentation before you file Form I-912 alongside your I-485 — remembering that a granted waiver applies to the USCIS fee, not the civil surgeon’s charge.
The I-485 filing fee gets you the government’s processing of your case. The I-693 medical exam fee gets you a licensed civil surgeon’s professional evaluation, required by USCIS but paid on its own terms. Knowing that split — and budgeting for it as two separate costs rather than one — is one of the more practical basics of getting through adjustment of status without an unpleasant surprise at the clinic front desk.