Somewhere in America right now, a person is sitting in a lab waiting room, about to learn how much forever chemical is flowing through their veins. They may be a firefighter from a station that used aqueous film-forming foam for decades. They may be a mother who just discovered her town's drinking water exceeded the new EPA limits for PFOA. They may be a veteran who spent years on a military base where PFAS-laden runoff seeped into the groundwater.
What they all share is a question: How bad is it?
The answer, frustratingly, is not straightforward. PFAS blood testing is real, commercially available, and increasingly accessible. But interpreting the results requires understanding a framework that most doctors have never been trained on and that federal agencies are still refining. At the EPR Foundation, we believe everyone deserves to understand what these tests measure, what the numbers mean, and — critically — what they do not.
What a PFAS Blood Test Actually Measures
A PFAS blood test — technically a serum or plasma test — measures the concentration of specific per- and polyfluoroalkyl substances in your bloodstream at the time of the draw. Results are reported in nanograms per milliliter (ng/mL). Most commercial panels test for between seven and fourteen individual PFAS compounds, with the most commonly measured being PFOS (perfluorooctane sulfonic acid), PFOA (perfluorooctanoic acid), PFHxS (perfluorohexane sulfonic acid), and PFNA (perfluorononanoic acid).
These four compounds account for the bulk of PFAS exposure in the general population. According to the CDC's National Health and Nutrition Examination Survey (NHANES), which has tracked PFAS blood levels in Americans since 1999, the geometric mean concentration of PFOS in U.S. adults was 4.25 ng/mL as of the 2017–2018 survey cycle. For PFOA, it was 1.42 ng/mL. Nearly every person tested in NHANES — more than 98 percent — had detectable levels of at least one PFAS compound in their blood.
That last point bears repeating. Almost all of us are carrying these chemicals. The question is not whether you have PFAS in your blood. It is how much.
The NASEM Framework: Three Tiers of Concern
In 2022, the National Academies of Sciences, Engineering, and Medicine (NASEM) published a landmark report titled Guidance on PFAS Exposure, Testing, and Clinical Follow-Up. It remains the most authoritative clinical framework for interpreting PFAS blood test results, and it is built around three tiers based on the sum of seven specific PFAS compounds in serum or plasma.
Below 2 ng/mL (total of measured PFAS): At this level, adverse health effects related to PFAS exposure are not expected. Standard medical care applies. No additional screening is recommended beyond what a patient would normally receive.
Between 2 and 20 ng/mL: This is where most Americans fall. NASEM characterizes this range as carrying a "potential for adverse health effects, particularly in sensitive populations." Clinicians should encourage exposure reduction if a source is identified and consider screening for dyslipidemia (abnormal cholesterol), hypertension during pregnancy, and breast cancer.
Above 20 ng/mL: Levels in this range are associated with an increased risk of adverse health effects. NASEM recommends prioritized screening for dyslipidemia in patients over age two, thyroid function testing for adults over eighteen, urinalysis to assess for kidney cancer signs in patients over forty-five, and evaluation for testicular cancer and ulcerative colitis in patients over fifteen. Exposure reduction efforts should be strongly encouraged.
These are not diagnostic thresholds. A result of 25 ng/mL does not mean you have cancer. A result of 1.5 ng/mL does not mean you are safe from all harm. The framework is a tool for guiding preventive care — for telling doctors where to look more carefully.
What the Test Cannot Tell You
This is where public understanding breaks down, and where we owe people honesty rather than false certainty.
A PFAS blood test cannot tell you when you were exposed. It cannot tell you where the exposure came from — your drinking water, your cookware, the firefighting foam at the base, or the food packaging you have been eating from for decades. It cannot predict whether you will develop a specific disease. And it cannot, by itself, be used to diagnose any medical condition.
What it can do is establish a baseline. If you live in a community with known PFAS contamination and your levels are significantly above the national average, that information is valuable. It can guide decisions about water filtration, dietary changes, and medical monitoring. If you take action to reduce exposure and retest a year or two later, a declining number is meaningful evidence that the intervention worked.
The CDC and the Agency for Toxic Substances and Disease Registry (ATSDR) have been careful to describe PFAS blood testing as "informative but not clinically actionable" in the traditional sense. There is no drug that removes PFAS from your body. There is no treatment protocol triggered by a specific number. The half-life of PFOS in the human body is estimated at three to five years; for PFOA, roughly two to four years. These chemicals leave slowly, and only if new exposure stops.
Who Should Get Tested
Not everyone needs a PFAS blood test. But certain populations face exposure risks that make testing a reasonable and, in some cases, important step.
Firefighters: Both career and volunteer firefighters who have used or been exposed to AFFF (aqueous film-forming foam) have documented elevated PFAS levels. The Department of Defense has offered blood testing to its firefighters since October 2020. The International Association of Fire Fighters has advocated for expanded testing. Firefighters also face dermal exposure through PFAS-containing turnout gear, a pathway that is only beginning to be studied in detail.
Military personnel and veterans: Hundreds of military installations across the United States have confirmed PFAS contamination in soil and groundwater, primarily from decades of AFFF use in training exercises. Service members who lived or worked on these bases — particularly near fire training areas — may carry elevated levels. The Department of Veterans Affairs will cover PFAS testing for veterans exposed to AFFF, though accessing this benefit requires navigating the VA healthcare system and demonstrating a connection to exposure.
Residents of contaminated communities: If your municipal water system has detected PFAS above EPA advisory levels, or if you live near an industrial facility, airport, or military base with known PFAS discharge, testing can help establish your personal exposure level. Communities in states like Michigan, North Carolina, New Hampshire, and New Mexico have conducted large-scale blood testing programs that revealed levels far above national averages.
Workers in PFAS-related industries: Employees at chemical manufacturing plants, semiconductor fabrication facilities, chrome plating operations, and certain textile or paper manufacturing sites may have occupational exposure.
People with private wells: Private wells are not subject to the Safe Drinking Water Act and are not monitored by municipal utilities. If you draw water from a private well in an area with potential PFAS sources, testing both your water and your blood is prudent.
The Cost Barrier
Knowing you should get tested is one thing. Paying for it is another.
A PFAS blood panel from Quest Diagnostics — one of the few nationally available consumer options — costs approximately $300 to $350 out of pocket, plus a physician service fee. LabCorp and specialty environmental health labs offer similar panels in the same price range. Most health insurance plans do not cover PFAS testing as routine screening. Coverage may be possible if a physician orders the test for a specific clinical indication and uses appropriate diagnostic codes, but this is inconsistent and depends heavily on the insurer.
A handful of states are beginning to address this gap. New Hampshire now requires insurers to cover PFAS blood testing. Maine introduced legislation in 2025 to mandate coverage for medically necessary testing. But for most Americans, PFAS blood testing remains an out-of-pocket expense — one that is prohibitively high for the communities most likely to need it.
This is an equity issue. The communities with the highest PFAS exposure are disproportionately low-income, rural, or located near military bases and industrial sites. Asking them to pay $350 for a test that their doctor may not know how to interpret is not a public health strategy. It is a gap.
What Your Doctor May Not Know
Here is an uncomfortable truth: most primary care physicians have received little to no training on PFAS exposure assessment or blood test interpretation. A 2024 ATSDR guidance document for clinicians — PFAS Information for Clinicians — was one of the first federal attempts to equip doctors with practical tools, and it acknowledged that many providers feel unprepared to counsel patients on results.
If you get tested, you may need to bring information to your doctor rather than the other way around. The NASEM report is publicly available. The ATSDR clinical guidance is free online. The CDC offers a PFAS Blood Level Estimation Tool that can help contextualize results based on known water contamination levels. Being an informed patient is not optional here — it is, for now, necessary.
What We Believe
The EPR Foundation supports expanded access to PFAS blood testing, particularly for high-exposure populations. We believe that testing should be affordable, that results should be interpreted through the NASEM framework, and that insurance coverage mandates should extend to all states, not just the few that have acted.
We also believe in honesty about limits. A blood test is not a verdict. It is a data point — one that gains meaning only when combined with exposure history, medical context, and ongoing monitoring. The science of PFAS health effects is advancing rapidly, and the clinical guidance of 2026 will look different from the guidance of 2030. That is how science works.
But waiting for perfect knowledge is not an option when millions of people are carrying chemicals in their blood that their bodies cannot clear. The first step is knowing what you are carrying. The second step is demanding that the systems responsible for this contamination help you understand — and address — what it means.
If you believe you have been exposed to PFAS through drinking water, occupation, or military service, talk to your healthcare provider about blood testing. If your provider is unfamiliar with PFAS, direct them to the ATSDR clinical resources at atsdr.cdc.gov/pfas. And if cost is a barrier, contact your state health department — some states offer free or subsidized testing for residents of contaminated communities.
You have a right to know what is in your blood. The numbers may not give you every answer, but they are the beginning of understanding.