Yes. Medi-Cal does cover TB tests, and eligible members pay nothing out of pocket. Tuberculosis screening is classified as a preventive service under Medi-Cal, following the U.S. Preventive Services Task Force’s grade B recommendation for screening adults at increased risk for latent TB infection. Because Medi-Cal covers all USPSTF grade A and B preventive services without cost-sharing, there is no copay or coinsurance for the test itself.1Medi-Cal. Medi-Cal Preventive Services2CDC. Tuberculosis Preventive Service Coverage
Which TB Tests Medi-Cal Pays For
Three screening methods are covered, each with its own billing code in the Medi-Cal preventive services manual: the tuberculin skin test, also called the Mantoux or PPD test (CPT 86580); the QuantiFERON-TB Gold Plus blood test, an interferon-gamma release assay (CPT 86480); and the T-SPOT.TB blood test (CPT 86481).1Medi-Cal. Medi-Cal Preventive Services3PMC. Tuberculosis Testing CPT Code Analysis Your provider decides which one to order based on your risk factors and clinical circumstances.
TB screening is flagged in the Medi-Cal billing guide with Modifier 33, the standard code that marks a service as preventive and exempt from cost-sharing.1Medi-Cal. Medi-Cal Preventive Services The test itself does not require prior authorization from a Medi-Cal managed care plan; your primary care physician can order it directly when risk factors are identified.4Health Net. Tuberculosis Detection and Treatment
Who Medi-Cal Expects to Be Screened
TB testing under Medi-Cal is risk-based, not universal. Not every member will be offered a test at every visit. Higher-risk groups that providers are asked to screen include:
- People living with HIV
- Close contacts of someone with active TB
- Individuals born in countries with high TB rates
- People who use injection drugs
- Residents and employees of congregate settings such as long-term care facilities
- People with medical conditions that weaken the immune system
Those criteria come from Medi-Cal managed care provider guidance.4Health Net. Tuberculosis Detection and Treatment
New Medi-Cal managed care members are entitled to an initial health appointment within 120 days of enrollment, and a TB test is required at that visit if the member falls into a high-risk category.4Health Net. Tuberculosis Detection and Treatment For children and adolescents up to age 20, screening follows the American Academy of Pediatrics Bright Futures guidelines, which call for a TB risk assessment during routine well-child visits.2CDC. Tuberculosis Preventive Service Coverage
A newer state law reinforces this. Assembly Bill 2132, signed by Governor Gavin Newsom in September 2024 and effective January 1, 2025, requires that adult primary care patients be offered a TB test when risk factors are identified, as long as their insurance covers it. Medi-Cal does, so providers treating Medi-Cal members are expected to comply.5CDPH. AB 2132 Implementation6LegiScan. AB 2132 Bill Text
How to Get a TB Test If You Have Medi-Cal
Most Medi-Cal members are enrolled in a managed care plan, and those members generally need to use in-network providers for covered services, including TB testing. L.A. Care’s member handbook, for example, states that members must get most covered services from in-network providers, with exceptions only for emergencies, family planning, and out-of-area urgent care.7L.A. Care. Medi-Cal Member Handbook – Provider Network
The usual path is to ask your assigned primary care provider for the test. If you don’t have one yet, your plan’s online directory or member services line can point you to a participating clinic.
If the Test Is Positive: What Else Is Covered
Coverage does not stop at the screening. If your result comes back positive, Medi-Cal covers the diagnostic workup that follows, including chest X-rays to check for active TB disease, laboratory services, and physician evaluation visits.8Santa Clara County. Medi-Cal TB Program Handbook9Medi-Cal. Medi-Cal Tuberculosis Program Manual
For latent TB infection, Medi-Cal covers the full course of treatment medications, including the shorter preferred regimens such as three months of weekly isoniazid plus rifapentine, four months of daily rifampin, and three months of daily isoniazid plus rifampin, along with the longer six- or nine-month daily isoniazid alternatives.10Medi-Cal Rx. Improving the Quality of Care – Treatment of Latent Tuberculosis Infection
For active TB disease, Medi-Cal covers physician visits, outpatient hospital care, laboratory and radiology services, prescription medications, case management, and Directly Observed Therapy.9Medi-Cal. Medi-Cal Tuberculosis Program Manual A referral to DOT does require authorization, and suspected or confirmed active cases must be reported by the provider to the local health department within one working day.4Health Net. Tuberculosis Detection and Treatment
If You Don’t Qualify for Full-Scope Medi-Cal
A separate Medi-Cal Tuberculosis Program, aid code 7H, provides outpatient TB-related services at zero share of cost for people who are infected with TB but don’t otherwise qualify for comprehensive Medi-Cal benefits. The program is funded under Title XIX of the Social Security Act.11DHCS. Medi-Cal Eligibility Manual – Tuberculosis Program
Free TB Testing Through County Health Departments
County public health departments across California also offer TB testing, often at no cost, regardless of insurance status. These clinics can be a useful option if you want a walk-in appointment or are uninsured.
- San Francisco: The San Francisco Free Clinic (4900 California Street) and the AITC Immunization and Travel Clinic (27 Van Ness Ave) offer testing by appointment. Multiple San Francisco Health Network clinics also provide testing for enrolled patients.12City and County of San Francisco. Get Tuberculosis (TB) Testing
- Orange County: The Orange County Health Care Agency clinic at 1725 West 17th Street in Santa Ana provides TB screening and treatment Monday through Friday, though skin testing is not done on Thursdays.13Orange County Health Care Agency. TB Clinic
- San Diego County: Regional public health centers offer testing for high-risk individuals who cannot access services elsewhere. Insured individuals are expected to use their own providers first.14San Diego County. Tuberculosis Control Program Clinic Services
Other counties run similar programs. Calling your local health department’s TB control office is the quickest way to find nearby options.