Effective Dates: 06/05/2017 - Present Previous | Next

Basic (09-06)

DI 39545.120 Sources and Types of Purchased Medical Services

A. Policy – purchasing medical services

  • •

    DDSs are authorized to purchase medical examinations, x-rays, and laboratory tests on a consultative basis to supplement evidence obtained from the claimants’ own medical sources when the evidence as a whole, both medical and nonmedical, is insufficient to make a disability determination.

  • •

    DDSs will purchase only the specific examinations and tests needed to make a disability determination. DDSs will not authorize a comprehensive medical examination when the only evidence needed is a special test, e.g., x-ray or electrocardiogram.

NOTE: SSA does not expect the claimant (or the claimant’s health insurance carrier) to pay for the cost of obtaining the evidence requested by the DDS. If the claimant reports that a CE Provider charged the claimant an additional fee, the DDS must resolve the issue with the CE Provider.

B. Definitions – types of purchased medical services

1. Consultative Examinations (CEs)

See DI 39545.075C.1. (e.g., psychiatric and psychological examinations, x-rays, and laboratory tests (including specialized tests such as pulmonary function studies, electrocardiograms and stress tests)).

2. Medical Evidence of Record (MER)

See DI 39545.075C.4. (e.g., abstracts, copies, narratives or teledictation of existing medical records and statements used to document disability claims).

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0439545120
DI 39545.120 - Sources and Types of Purchased Medical Services - 06/05/2017
Batch run: 06/05/2017
Rev:06/05/2017