Consultative Examinations

Saturday, April 1st, 2017

The POMS revised its rules regarding a consultative examination (“CE”). A claimant’s own medical source, which does not have to be a physician, “is generally the preferred CE source.”

The State agency is supposed to schedule a CE with your doctor who: is qualified; has adequate training and experience necessary to perform the types of examinations and tests needed; has access to the equipment required to perform the types of examinations and tests needed; is willing to perform the examination or test for the fee schedule payment; and is willing to provide a detailed written report of the examination in a timely manner.

The State agency will assume your doctors are not willing to do a CE if they failed or refused to provide medical evidence when asked. The State agency frequently asks treating doctors if they are willing to do a CE – in small print – on their letters to doctors that request medical records. The State agency might also call to ask if your doctor would do a CE.

If you are applying for Social Security Disability (“SSD”) benefits, you should tell your doctors in advance to say that they will do the CE, or to send any letter they receive from the State agency to you or your attorney to respond. You should also arrange to pay the difference between what the State agency will pay for the CE and what your doctor will accept to avoid payment from being an obstacle for your doctor to do the CE.

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