On October 20, 2025, the U.S. Citizenship and Immigration Services (USCIS) released its most comprehensive guidance to date regarding the $100,000 H-1B petition fee announced under the September 19, 2025 Presidential Proclamation. This update published on USCIS.gov clarifies many aspects of the fee requirement, but significant ambiguities remain.
For healthcare organizations seeking to hire international nurses or other skilled professionals through the H-1B visa program, understanding these rules is critical to avoiding costly delays or denials.
Key Confirmations from USCIS
Under the new rules, the $100,000 H-1B fee applies to any petition filed after 12:01 a.m. EDT on September 21, 2025 if the following conditions are met:
The beneficiary (the international worker) is currently outside the United States
The worker does not hold a valid H-1B visa
The petition requests consular notification as the "requested action" on Form I-129
OR USCIS approves the petition but denies a change or extension of status, or the beneficiary leaves the U.S. while the petition is pending
When the Fee Does NOT Apply
Healthcare employers are exempt from the burden of this fee if:
The petition was filed before 12:01 AM EDT on September 21, 2025
The petition requests Change of Status (COS), Extension of Status (EOS), or an Amendment and USCIS approves it
The visa application is based on an H-1B petition approved under COS/EOS/Amendment
The admission is based on a new visa issued from such approved petitions or through a “current valid H-1B visa”
Note: USCIS has yet to clarify the exact scope of the "current valid H-1B visa" exemption.
Paying the $100,000 H-1B Fee
Petitioners including hospitals and healthcare staffing firms must submit payment before filing the petition through Pay.gov using the official USCIS payment link:
➡ [Pay.gov H-1B Payment Portal](https://www.pay.gov/public/form/start/1772005176)
Important:
- The passport details entered must match the passport the nurse presents at U.S. entry.
- Petitions lacking proof of payment will be denied, unless a National Interest Exception (NIE) is granted.
- Proof of payment is critical USCIS has begun issuing Requests for Evidence (RFEs) when payment confirmation is missing.
- If USCIS denies the petition, the fee will be refunded per the Pay.gov guidelines.
Payment-related inquiries can be sent to: H1BVisaRRP@hq.dhs.gov
National Interest Exceptions (NIE) A Rare Lifeline for Healthcare Employers
Healthcare organizations facing the $100,000 fee may request an NIE if an H-1B worker’s presence is considered vital to U.S. national interests.
Requests must be submitted with compelling evidence to: H1BExceptions@hq.dhs.gov
The Secretary of DHS may approve NIE requests only in extraordinary circumstances, when:
- The nurse or other healthcare worker’s role is deemed in the national interest (e.g., critical to patient care in shortage areas)
- No qualified U.S. worker is available for the position
- Requiring payment would significantly undermine U.S. interests
- The beneficiary poses no risk to U.S. security or welfare
USCIS has provided no clear guidance on what evidence is required whether a labor market test, shortage data for certain healthcare roles, or proof of unemployment rates is necessary.
Outstanding Questions and Potential Impact on Nurse Recruitment
Several uncertainties affect healthcare recruiters and employers:
Whether a valid H-1B visa protects future petitions filed during its active period for different employers or positions
Whether industry-wide or occupation-specific NIEs (such as for nursing in shortage areas) will be allowed
Whether USCIS will implement expedited NIE review for urgent healthcare staffing needs
Who will review NIE requests and the extent of their training, especially for complex healthcare cases
What Healthcare Employers Should Do Now
Hospitals, long-term care facilities, and healthcare staffing agencies should:
- Review upcoming recruitment plans for international nurses and other healthcare professionals
- File petitions early to avoid the new fee where possible
- Gather evidence of shortage and national interest impact, in case an NIE becomes necessary
- Consult an experienced immigration law firm like VisaMadeEZ to navigate USCIS policies and respond quickly to RFEs
VisaMadeEZ specializes in healthcare immigration and has helped numerous hospitals successfully hire international nurses despite complex visa changes. We can assist with:
- H-1B visa filings and compliance
- National Interest Exception requests
- Strategy planning to avoid unnecessary costs
Need help on the new $100,000 H-1B fee?
Contact VisaMadeEZ today our healthcare immigration attorneys will guide you through the latest USCIS requirements and secure the talent your patients need.
