Effective Dates: 04/02/2024 - Present Previous | Next

TN 41 (04-24)

DI 22510.001 Introduction to Consultative Examinations

CITATIONS:

20 CFR sections
404.1517, 404.1519 through 404.1519t, 416.917, and 416.919 through 416.919t.

A. Definitions

1. Consultative examination (CE)

A CE is a physical or mental examination or test purchased from a medical source, at the Social Security Administration's (SSA) request and expense, to provide evidence for a claimant’s disability or blindness claim. In addition to in-person CEs, SSA offers telehealth and video CEs in some circumstances.

a. Telehealth consultative examination (THCE)

A THCE is a CE that:

  • •

    Uses audio and video technology to allow remote interaction between a CE source and a claimant or beneficiary;

  • •

    Requires the claimant or beneficiary to participate using a personal device at their home or other private location; and

  • •

    Requires the claimant or beneficiary to participate using a platform selected by the CE source.

For detailed information about THCEs, see DI 22510.013.

b. Video consultative examination (VCE)

A VCE is a CE that:

  • •

    Uses audio and video technology to allow remote interaction between a CE source and a claimant or beneficiary;

  • •

    Requires the claimant or beneficiary to participate using equipment at a location provided by SSA or the Disability Determination Services (DDS); and

  • •

    Requires the claimant or beneficiary and the CE source to access the connection using a platform selected by SSA or DDS.

For detailed information on VCEs, see DI 22510.012.

2. Medical source

A medical source is an individual who is either:

  • •

    Licensed as a healthcare worker by a State and working within the scope of practice permitted under State or Federal law, or

  • •

    Certified by a State as a speech-language pathologist or a school psychologist and acting within the scope of practice permitted under State or Federal law.

a. Acceptable medical source (AMS)

An AMS is a medical source who may provide evidence we use to establish the existence of a medically determinable impairment (MDI). For detailed information about acceptable medical sources, see DI 22505.003.

b. Claimant's own medical source

A claimant's own medical source is a medical source who:

  • •

    Provides or has provided the claimant with evaluation, examination, or treatment; and

  • •

    Has or has had an ongoing treatment relationship with the claimant.

c. CE source

A CE source is a medical source who performs a CE. SSA only uses qualified CE sources to perform CEs.

d. Qualified CE source

A qualified CE source is a medical source who:

  • •

    Is currently licensed (or certified in the case of a psychologist, or otherwise qualified in the case of a speech-language pathologist) in the State in which they perform the CE;

  • •

    Has the training and experience to perform the type of examination or test requested; and

  • •

    Is not barred from participation in Medicare or Medicaid programs or any other Federal or federally assisted programs.

A qualified medical source may also be an AMS or the claimant's own medical source.

For information on:

  • •

    Selecting a qualified source for a CE and the qualifications required of support staff assisting a qualified medical source in performing a CE, see DI 22510.010.

  • •

    When to obtain a CE from the claimant's own medical source, see DI 22510.010D.

  • •

    CE source licensure, see DI 39569.300.

  • •

    Program integrity considerations, see DI 39569.200A.

B. Supervisory approval for CEs

DDS may require supervisory approval for the authorization or purchase of CEs. Follow your DDS business process regarding supervisory approval.

If the CE could involve significant risk to the claimant, see DI 22510.006C.

C. Payment for CEs

  • •

    SSA pays for any CE ordered for the claimant; and

  • •

    SSA does not pay for any medical examination arranged by the claimant or the claimant's appointed representative unless it is approved in advance.

For more information on purchasing CEs, see DI 39545.000.

D. Procedures for ordering a CE

  1. 1. 

    Make the decision to purchase a CE on an individual case basis and consistent with instructions in DI 22510.005 and DI 22510.006.

  2. 2. 

    Select an appropriate CE source. (See DI 22510.010.)

  3. 3. 

    Notify the CE source in writing. (See DI 22510.017A.)

  4. 4. 

    Provide the CE source supporting evidence, if appropriate. (See DI 22510.017B.)

  5. 5. 

    If ordering a CE for a case pending a hearing, see additional instructions in DI 29501.010.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0422510001
DI 22510.001 - Introduction to Consultative Examinations - 04/02/2024
Batch run: 11/13/2024
Rev:04/02/2024