Each State should be cost-efficient and make every attempt to negotiate fees below
the highest allowable rates.
DDS should not enter into any negotiated agreement that would result in fee payments
in excess of the maximum amount of their fee schedule without obtaining prior written
approval from the RO.
States must follow federal and state guidance (including State Agency Fee Schedule)
when seeking approval for charges that exceed the fee schedule. This includes costs
for travel (airfare, car, etc), per diem for food, and lodging.
Regional Offices review requests and maintain records when medical services exceed
the fee schedule.
DDS report costs in the Medical Costs of Consultative Examinations section of the
eMOR and Form SSA-4513 – State Agency Report of Obligations for SSA Disability Programs.
NOTE: Do not record costs for medical services above the fee schedule in the
Other or Applicant Travel section of the eMOR under any circumstance.
States must provide a description of any CE fee schedule changes and all exceptions
(include a description of any volume medical provider discounts) in the Annual Oversight
DDS are responsible for maintaining oversight of all CE providers to ensure compliance
with the CE procedures and fee schedules.