For purposes of an installment agreement, the IRS will often allow higher than their standards. For an Offer in Compromise there are situations where the standards may be exceeded. They typically will allow higher than the out-of-pocket medical expense allowance if the higher amount can be substantiated. Be prepared to make the argument that there is a reason for exceeding the standards as it will be questioned. Also, put a letter with the offer so that it is not returned as non-processable.