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 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.
The DDS must maintain the RO’s written response for audit purposes.