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20 C.F.R. §§ 404.1519g–404.1519j

4 sections in range

§404.1519g. Who we will select to perform a consultative examination.

20 C.F.R. § 404.1519g

(a)
We will purchase a consultative examination only from a qualified medical source. The medical source may be your own medical source or another medical source. If you are a child, the medical source we choose may be a pediatrician.
(b)
By “qualified,” we mean that the medical source must be currently licensed in the State and have the training and experience to perform the type of examination or test we will request; the medical source must not be barred from participation in our programs under the provisions of § 404.1503a. The medical source must also have the equipment required to provide an adequate assessment and record of the existence and level of severity of your alleged impairments.
(c)
The medical source we choose may use support staff to help perform the consultative examination. Any such support staff (e.g., X-ray technician, nurse) must meet appropriate licensing or certification requirements of the State. See § 404.1503a.
Notes, amendments, and revision history

Amendments

[56 FR 36957, Aug. 1, 1991, as amended at 65 FR 11876, Mar. 7, 2000; 82 FR 5866, Jan. 18, 2017]

Authority

Authority: 42 U.S.C. 402, 405(a)-(b) and (d)-(h), 416(i), 421(a) and (h)-(j), 422(c), 423, 425, 902(a)(5), and 1320e-3; sec. 211(b), Pub. L. 104-193, 110 Stat. 2105, 2189; sec. 202, Pub. L. 108-203, 118 Stat. 509 (42 U.S.C. 902 note).

Source

Source: 45 FR 55584, Aug. 20, 1980, unless otherwise noted.

Amendments

[56 FR 36957, Aug. 1, 1991, as amended at 65 FR 11876, Mar. 7, 2000; 82 FR 5866, Jan. 18, 2017]

§404.1519h. Your medical source.

20 C.F.R. § 404.1519h

When, in our judgment, your medical source is qualified, equipped, and willing to perform the additional examination or test(s) for the fee schedule payment, and generally furnishes complete and timely reports, your medical source will be the preferred source for the purchased examination or test(s).
Notes, amendments, and revision history

Amendments

[82 FR 5866, Jan. 18, 2017]

Authority

Authority: 42 U.S.C. 402, 405(a)-(b) and (d)-(h), 416(i), 421(a) and (h)-(j), 422(c), 423, 425, 902(a)(5), and 1320e-3; sec. 211(b), Pub. L. 104-193, 110 Stat. 2105, 2189; sec. 202, Pub. L. 108-203, 118 Stat. 509 (42 U.S.C. 902 note).

Source

Source: 45 FR 55584, Aug. 20, 1980, unless otherwise noted.

Amendments

[82 FR 5866, Jan. 18, 2017]

§404.1519i. Other sources for consultative examinations.

20 C.F.R. § 404.1519i

We will use a different medical source than your medical source for a purchased examination or test in situations including, but not limited to, the following:
(a)
Your medical source prefers not to perform such an examination or does not have the equipment to provide the specific data needed;
(b)
There are conflicts or inconsistencies in your file that cannot be resolved by going back to your medical source;
(c)
You prefer a source other than your medical source and have a good reason for your preference;
(d)
We know from prior experience that your medical source may not be a productive source, such as when he or she has consistently failed to provide complete or timely reports; or
(e)
Your medical source is not a qualified medical source as defined in § 404.1519g.
Notes, amendments, and revision history

Amendments

[82 FR 5866, Jan. 18, 2017]

Authority

Authority: 42 U.S.C. 402, 405(a)-(b) and (d)-(h), 416(i), 421(a) and (h)-(j), 422(c), 423, 425, 902(a)(5), and 1320e-3; sec. 211(b), Pub. L. 104-193, 110 Stat. 2105, 2189; sec. 202, Pub. L. 108-203, 118 Stat. 509 (42 U.S.C. 902 note).

Source

Source: 45 FR 55584, Aug. 20, 1980, unless otherwise noted.

Amendments

[82 FR 5866, Jan. 18, 2017]

§404.1519j. Objections to the medical source designated to perform the consultative examination.

20 C.F.R. § 404.1519j

You or your representative may object to your being examined by a medical source we have designated to perform a consultative examination. If there is a good reason for the objection, we will schedule the examination with another medical source. A good reason may be that the medical source we designated had previously represented an interest adverse to you. For example, the medical source may have represented your employer in a workers' compensation case or may have been involved in an insurance claim or legal action adverse to you. Other things we will consider include: The presence of a language barrier, the medical source's office location (e.g., 2nd floor, no elevator), travel restrictions, and whether the medical source had examined you in connection with a previous disability determination or decision that was unfavorable to you. If your objection is that a medical source allegedly “lacks objectivity” in general, but not in relation to you personally, we will review the allegations. See § 404.1519s. To avoid a delay in processing your claim, the consultative examination in your case will be changed to another medical source while a review is being conducted. We will handle any objection to use of the substitute medical source in the same manner. However, if we had previously conducted such a review and found that the reports of the medical source in question conformed to our guidelines, we will not change your examination.
Notes, amendments, and revision history

Amendments

[65 FR 11876, Mar. 7, 2000]

Authority

Authority: 42 U.S.C. 402, 405(a)-(b) and (d)-(h), 416(i), 421(a) and (h)-(j), 422(c), 423, 425, 902(a)(5), and 1320e-3; sec. 211(b), Pub. L. 104-193, 110 Stat. 2105, 2189; sec. 202, Pub. L. 108-203, 118 Stat. 509 (42 U.S.C. 902 note).

Source

Source: 45 FR 55584, Aug. 20, 1980, unless otherwise noted.

Amendments

[65 FR 11876, Mar. 7, 2000]