TN 2 (08-21)

DI 71001.050 Disability Determination Services (DDS) Procedures for Payment of Medical Services above the Fee Schedule

The Disability Determination Services (DDS) must obtain regional office (RO) approval before agreeing to pay any charges that exceed the consultative examinations (CE) or the medical evidence of record (MER) fee schedule, or both. If it is necessary to pay a charge that exceeds the DDS fee schedule for MER or a CE, the DDS must submit a written request to the regional office requesting a fee schedule exception. The DDS must maintain the RO's written response for audit purposes. The exception request must:

  • Explain why it is necessary to pay a fee above the schedule;

  • Outline any difficulties in obtaining the medical evidence, necessary test(s) or negotiating a fee; and

  • Explain how the proposed fee was determined.

  • States must follow state guidance (including State Agency Fee Schedule) when approving expenses for charges that exceed the fee schedule. This includes costs for travel (airfare, car, etc) per diem for food and lodging.

  • DDS reports 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.

Do not record costs for medical services above the fee schedule in the Other or Applicant Travel section of the eMOR under any circumstance.

 

See also


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0471001050
DI 71001.050 - Disability Determination Services (DDS) Procedures for Payment of Medical Services above the Fee Schedule - 08/03/2021
Batch run: 08/03/2021
Rev:08/03/2021