Tuberculosis (TB) Testing
Guidelines & Requirements
(Updated 10/15/2026)
The Indiana Department of Health requires all caregivers (Personal Care Assistants) employed
by a home care agency to complete 2-Step Tuberculosis (TB) Testing prior to employment.
What Is 2-Step TB Testing?
2-Step TB Testing requires two separate TB tests completed at least three (3) weeks apart.
This requirement helps establish an accurate baseline TB screening for healthcare workers.
Testing Methods
● TB Skin Test (PPD): Requires two visits; one visit for placement and one for reading.
● QuantiFERON®-TB Gold Blood Test: Requires one visit for the blood draw.
● Chest X-Ray: Accepted when accompanied by required medical documentation.
Acceptable TB Screening Documentation
Applicants may provide any of the following:
● Negative TB Skin Test (PPD) results
● Negative QuantiFERON®-TB Gold blood test results
● Negative Chest X-Ray results
Important: If you choose to provide a chest x-ray in lieu of TB skin testing, you must notify our
office before obtaining the x-ray. A required medical form must be completed by your healthcare
provider and submitted along with the chest x-ray report.
Cost of Testing
Applicants are responsible for the cost of all TB testing.
Many health insurance plans cover TB testing; however, coverage varies by provider. We
recommend contacting your insurance company in advance to verify benefits and any
out-of-pocket costs.
BCG Vaccination and False-Positive TB Skin Tests
Individuals who received the Bacille Calmette-Guérin (BCG) vaccine, which is commonly
administered at birth in many countries outside the United States, may experience a
false-positive result on a TB skin test (PPD). If a TB skin test is positive, additional
testing may be required to confirm the absence of active or latent tuberculosis.
Acceptable follow-up testing may include a QuantiFERON®-TB Gold blood test or a
chest x-ray, as directed by agency requirements. Applicants who have a known history of
false-positive TB skin tests due to prior BCG vaccination may wish to consider obtaining
a QuantiFERON®-TB Gold blood test initially, as it is generally not affected by prior BCG
vaccination. The applicant will have to provide a negative test result AFTER their false
positive result to confirm there is no active tuberculosis present.
For Individuals Who Prefer to Avoid Injections or Vaccinations: TB Testing Alternatives
Careworthy respects that individuals may have personal, medical, or religious concerns regarding injections. Employees and prospective employees who prefer not to receive a TB skin test may choose an alternative testing method, subject to Careworthy’s TB testing requirements and applicable Indiana guidelines.
Acceptable alternatives may include:
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QuantiFERON-TB Gold blood test: A blood draw that does not require an injection of TB testing solution under the skin, as the blood specimen is tested after it is collected.
-
Chest X-ray with supporting documentation: A chest X-ray accompanied by documentation from a qualified healthcare provider confirming the results and that the individual does not have active tuberculosis, when accepted under applicable requirements.
Employees who have concerns about TB skin testing are encouraged to discuss these alternatives with their healthcare provider. All required testing and documentation must be submitted to Careworthy and meet applicable requirements before the employee may begin or continue work, as required by company policy and applicable law.
Employment Start Requirements
You cannot begin working until documentation of the first required TB test has been
submitted to our agency.
The second test must be completed according to the Indiana Department of Health's 2-Step TB
testing requirements and submitted as soon as it becomes due.
For TB testing locations, click here.
Questions?
If you have questions regarding TB testing requirements, acceptable documentation, or the
chest x-ray process, please contact our office. We are happy to assist you through the process.
We can be reached at (317) 296-3852.