Identification Number:
DI 24598 TN 3
Intended Audience:See Transmittal Sheet
Originating Office:ORDP ODP
Title:Evaluation of Specific Issues - Growth Impairment
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 245 – Medical Evaluation
Subchapter 98 – Evaluation of Specific Issues - Growth Impairment
Transmittal No. 3, 05/09/2022

Audience

PSC: DE, DEC;
OCO-OEIO: CR, ERE, FDE, RECONE;
OCO-ODO: DE, DEC, DS, RECONE;
ODD-DDS: ADJ, DHU;

Originating Component

ODP

Effective Date

Upon Receipt

Background

The table in listing 100.04B does not describe gestational age (GA) in weeks and days. Due to questions received regarding how to use the table in listing 100.04B when gestational age falls between the categories; this transmittal reflects the addition of a table that includes birth weights that are less than the 3rd percentile for GA in weeks AND days.

 

Summary of Changes

DI 24598.003 Low Birth Weight (LBW)

This section has been reorganized for clarity and provides guidance for determining birth weights that are less than the 3rd percentile for GA in weeks and days.

DI 24598.003 Low Birth Weight (LBW)

A. What is Birth Weight?

In listing sections 100.04A and 100.04B, birth weight is the first weight recorded after birth.

B. What is Low Birth Weight (LBW)?

LBW is a birth weight:

  • less than 1200 grams; or

  • 2000 grams or less and small for gestational age (less than the 3rd percentile).

C. What is Gestational Age (GA)?

GA is the infant's age based on the date of conception as recorded in the medical record. GA may be:

  1. a. 

    expressed in terms of the time elapsed from the first day of the last menstrual period of the mother; or

  2. b. 

    calculated based on certain physical signs at birth using scoring systems designed for this purpose, such as the Dubowitz forms for assessment.

If there is a significant discrepancy between the GA calculated using these two methods, the age determined based on the physical signs is usually more accurate.

D. When is LBW not a medically determinable impairment (MDI)?

LBW is not an MDI:

  • for infants whose birth weight is more than 2000 grams

  • for children over age 1

E. When is LBW an MDI?

LBW is an MDI for infants from birth to the attainment of age 1 whose birth weight is 2000 grams or less.

Note: While many LBW infants are born prematurely, prematurity is not a prerequisite for the establishment of an MDI of LBW.

F. When is it appropriate to establish LBW as an MDI?

Establish LBW when we have the following documentation recording a qualifying birth weight:

  • an original or certified copy of the infant’s birth certificate; or

  • a medical record signed by an acceptable medical source.

1. Listing 100.04

Evaluate LBW under listing 100.04 in infants from birth to attainment of age l. If the infant's MDI meets the requirements for 100.04A and 100.04B, see DI 25235.006 Medical Diary Criteria for Low Birth Weight (LBW) Infants under Title XVI.

Note: Values in the table in 100.04B represent the weight considered small for GA (that is, less than the 3rd percentile). The table does not include a value for GAs below 31 weeks because the small for GAgestational age value for 31 weeks or below because the small for GA is less than 1200 grams, which is the criterion in 100.04A. The table also does not include values for GAs above 40 weeks because the small for GA value is above 2000 grams, which is the maximum birth weight considered under 100.04B.

2. Evaluating LBW under listing 100.04B with a GA reported in weeks and days

  1. a. 

    The table in listing 100.04B does not describe GA in weeks and days; therefore, a GA in weeks and days, and an accompanying birth weight that is less than the 3rd percentile for that GA, is a finding of equivalent severity and duration to the listing requirement, which means the impairment medically equals the listing.

  2. b. 

    Birth weights that are less than the 3rd percentile for GA in weeks AND days are shown in the table below:

Gestational Age

Birth Weight

Weeks

Days

37-40

n/a

2000 grams or less

36

6

1982 grams or less

36

5

1964 grams or less

36

4

1946 grams or less

36

3

1929 grams or less

36

2

1911 grams or less

36

1

1893 grams or less

36

0

1875 grams or less

35

6

1850 grams or less

35

5

1825 grams or less

35

4

1800 grams or less

35

3

1775 grams or less

35

2

1750 grams or less

35

1

1725 grams or less

35

0

1700 grams or less

34

6

1671 grams or less

34

5

1643 grams or less

34

4

1614 grams or less

34

3

1586 grams or less

34

2

1557 grams or less

34

1

1529 grams or less

34

0

1500 grams or less

33

6

1475 grams or less

33

5

1450 grams or less

33

4

1425 grams or less

33

3

1400 grams or less

33

2

1375 grams or less

33

1

1350 grams or less

33

0

1325 grams or less

32

6

1314 grams or less

32

5

1304 grams or less

32

4

1293 grams or less

32

3

1282 grams or less

32

2

1271 grams or less

32

1

1261 grams or less

32

0

1250 grams or less

31

6

1243 grams or less

31

5

1236 grams or less

31

4

1229 grams or less

31

3

1221 grams or less

31

2

1214 grams or less

31

1

1207 grams or less

31

0

1200 grams or less

 


DI 24598 TN 3 - Evaluation of Specific Issues - Growth Impairment - 5/09/2022