Basic (09-06)

DI 39545.175 Authorizing Consultative Examinations (CEs)

DDS examiners, supervisors, medical consultants (MCs) and psychological consultants (PCs) will ensure that only necessary and appropriate CEs are purchased.

A. Policy – DDS Responsibilities

  • Ensure CEs are purchased from qualified medical sources. To be qualified, the medical source must be licensed or certified in the State in which the CE is performed and have the training and experience to perform the type of examination or test requested. (See Ensuring Proper Licensure of CE Providers, DI 39569.300.)

  • Confirm licensing status and sanction status before using any medical sources to perform CEs

  • Ensure CE volume providers or clinics that employ CE panelists to perform CEs require each CE panelist to sign a License/Credentials Certification Statement (see exhibit, DI 39569.400).

  • Purchase only the specific examinations and tests needed to make a disability determination.

B. Policy – Diagnostic Tests and Procedures

  • MCs must approve the ordering of any diagnostic test or procedure when there is a chance it may involve significant risk.

  • Diagnostic tests or procedures that are invasive and involve significant risks, such as myelograms, arteriograms, or cardiac catheterizations should not be ordered (see DI 22510.006, When Not to Purchase a CE).

C. Policy – Administrative Law Judge (ALJ) CE Requests

  • MCs must approve ALJ CE requests for diagnostic tests or procedures that involve significant risk to a claimant.

  • ALJ CE requests that appear to be inappropriate are referred to the DDS CE Coordinator to discuss with their ODAR counterpart. Alternative means of obtaining the information may be suggested for the ALJ’s consideration. ALJs should not request CE assistance when invasive procedures are involved.

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DI 39545.175 - Authorizing Consultative Examinations (CEs) - 09/21/2007
Batch run: 07/11/2011