20 CFR 416.919k - Purchase of medical examinations, laboratory tests, and other services.

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There are 7 Updates appearing in the Federal Register for 20 CFR 416. View below or at eCFR (GPOAccess)
§ 416.919k Purchase of medical examinations, laboratory tests, and other services.
We may purchase medical examinations, including psychiatric and psychological examinations, X-rays and laboratory tests (including specialized tests, such as pulmonary function studies, electrocardiograms, and stress tests) from a medical source.
(a) The rate of payment for purchasing medical or other services necessary to make determinations of disability may not exceed the highest rate paid by Federal or public agencies in the State for the same or similar types of service. See §§ 416.1024 and 416.1026 of this part.
(b) If a physician's bill, or a request for payment for a physician's services, includes a charge for a laboratory test for which payment may be made under this part, the amount payable with respect to the test shall be determined as follows:
(1) If the bill or request for payment indicates that the test was personally performed or supervised by the physician who submitted the bill (or for whose services the request for payment was made) or by another physician with whom that physician shares his or her practice, the payment will be based on the physician's usual and customary charge for the test or the rates of payment which the State uses for purchasing such services, whichever is the lesser amount.
(2) If the bill or request for payment indicates that the test was performed by an independent laboratory, the amount of reimbursement will not exceed the billed cost of the independent laboratory or the rate of payment which the State uses for purchasing such services, whichever is the lesser amount. A nominal payment may be made to the physician for collecting, handling and shipping a specimen to the laboratory if the physician bills for such a service. The total reimbursement may not exceed the rate of payment which the State uses for purchasing such services.
(c) The State will assure that it can support the rate of payment it uses. The State shall also be responsible for monitoring and overseeing the rate of payment it uses to ensure compliance with paragraphs (a) and (b) of this section.
[56 FR 36965, Aug. 1, 1991, as amended at 65 FR 11879, Mar. 7, 2000; 71 FR 16459, Mar. 31, 2006; 76 FR 24810, May 3, 2011]

Title 20 published on 2012-04-01

The following are only the Rules published in the Federal Register after the published date of Title 20.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2013-11-06; vol. 78 # 215 - Wednesday, November 6, 2013
    1. 78 FR 66638 - Extension of the Expiration Date for State Disability Examiner Authority To Make Fully Favorable Quick Disability Determinations and Compassionate Allowances
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      SOCIAL SECURITY ADMINISTRATION
      Final rule.
      This final rule is effective November 6, 2013.
      20 CFR Parts 404 and 416

This is a list of United States Code sections, Statutes at Large, Public Laws, and Presidential Documents, which provide rulemaking authority for this CFR Part.

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United States Code
U.S. Code: Title 8 - ALIENS AND NATIONALITY
U.S. Code: Title 31 - MONEY AND FINANCE
U.S. Code: Title 42 - THE PUBLIC HEALTH AND WELFARE
U.S. Code: Title 48 - TERRITORIES AND INSULAR POSSESSIONS
U.S. Code: Title 49 - TRANSPORTATION
Statutes at Large

Title 20 published on 2012-04-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 20 CFR 416 after this date.

  • 2014-02-20; vol. 79 # 34 - Thursday, February 20, 2014
    1. 79 FR 9663 - Submission of Evidence in Disability Claims
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      SOCIAL SECURITY ADMINISTRATION
      Notice of proposed rulemaking (NPRM).
      To ensure that your comments are considered, we must receive them by no later than April 21, 2014.
      20 CFR Parts 404, 405, and 416