TN 9 (06-13)

DI 23022.053 Coding for All Compassionate Allowances and Quick Disability Determinations Fast-Track Cases

Regulations, effective November 12, 2010, temporarily permit each disability examiner (DE) in the disability determination services (DDS) to issue fully favorable determinations adjudicated under the Compassionate Allowances (CAL) and Quick Disability Determinations (QDD) initiative procedures, as described in DI 23023.000.

Under the regulations, the program will end on December 28, 2018, unless we end it earlier or decide to extend it. We need information from each DE to evaluate the success of the program properly.

NOTE: You must fully document either a DE or a team determination for each CAL or QDD case.

A. DE determination

A DE determination means a determination you make under the authority in DI 23023.001. These codes apply when a DE alone is responsible for the determination, including when a medical consultant or psychological consultant (MC/PC) provided consultation but did not sign disability forms.

You must enter one of the following disability-related list codes into Item 26D on the Form SSA-831 (Disability Determination and Transmittal) for each fast-track claim:

  1. 360 – DE determination, no MC/PC involvement

  2. 361 – DE determination, MC/PC consultation only (no disability forms signed by the MC/PC used in the determination)

  3. 362 – DE determination, MC/PC consultation with disability forms signed by the MC/PC

NOTE: Use code 361 when you are making the determination with verbal consultation with the MC/PC (e.g., required opinion regarding medical equivalence, verbal consultation, no disability forms signed by an MC/PC).

NOTE: Use code 362 when asking for consultation (for any reason) and an MC/PC signed the disability forms; however, the DE is still solely responsible for the determination as allowed in DI 23023.001.

B. Team determination

A team determination means a DE and a MC/PC are jointly responsible for the determination.

Enter one of the following disability-related list codes into Item 26D on the Form SSA-831 for each claim.

  1. 363 – Team determination, DE authorized to make QDD and CAL determinations as it is allowed under DI 23023.001, but MC/PC signature required because of statutory or policy requirement for MC/PC involvement (e.g., title XVI childhood disability, closed period, concurrent with less-than-fully-favorable determination on one claim); or

  2. 364 – Team determination, DE not authorized to make QDD and CAL determinations under this subchapter, MC/PC signature required (any type of claim).

NOTE: Use code 364 if you are a DE who does not have the authority to make independent CAL or QDD determinations and must always make a determination with an MC/PC. If you are such a DE, always use code 364 regardless of the type of claim or whether the determination is favorable or unfavorable.


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0423022053
DI 23022.053 - Coding for All Compassionate Allowances and Quick Disability Determinations Fast-Track Cases - 12/05/2016
Batch run: 12/05/2016
Rev:12/05/2016