TN 2 (09-04)

DI 25205.015 Consultative Examinations (CE)

A. Policy - general

  1. 1. 

    When additional medical information is needed, apply the general guidelines for purchasing a CE (DI 22510.005) and for selecting a CE source (DI 22510.010).

  2. 2. 

    When a child’s medical source(s) cannot or will not provide the needed information, even by performing a CE, apply the following guidelines for selecting a CE source:

    1. a. 

      To document the existence of a medically determinable impairment in a child, make reasonable efforts to obtain a CE from a qualified pediatrician.

      • If a qualified pediatrician is not available, obtain the CE from the most appropriate acceptable medical source that is available. See DI 22510.010.

      • For documentation of a medically determinable mental impairment in infants and toddlers, a developmental pediatrician may be the best qualified CE source.

    2. b. 

      If a medically determinable mental or physical impairment has been established, a CE may be purchased from a qualified health care provider who is not an acceptable medical source to show the severity of the physical or mental impairment and its effect on the child’s functioning. This evidence is then used in conjunction with the evidence from the acceptable medical source and other sources to assess the severity of the impairment and the child’s functioning.

  3. 3. 

    When selecting a CE source in a child’s case, keep in mind the requirements given in the general Pediatric CE Report Content Guidelines in DI 22510.035, and for specific body systems in DI 22510.036 through DI 22510.060.

B. Policy - failure or refusal to appear for a CE

Failure or refusal to appear for a CE is not an automatic basis for a denial or termination action. See DI 25205.020, regarding the policies and procedures for failure issues in child cases.

To Link to this section - Use this URL:
DI 25205.015 - Consultative Examinations (CE) - 09/10/2004
Batch run: 12/02/2014