ML202 - Sedgwick Claims Management Services: Grade F

ML202 - Sedgwick Claims Management Services: Grade F

Claims administrator failed to properly reimburse ML202. Sedgwick incorrectly underpaid valid medical-legal code as “exceeds the official medical fee schedule allowance.” Date of Service: 04/06/2021

MLFS Code(s)

ML202 - Follow-up Medical-Legal Evaluation

MLFS Modifier(s)

93 - Interpreter needed at time of examination

MLFS Grade

F

Claims Administrator

Sedgwick Claims Management Services

Bill Review Vendor

Coventry Workers Comp Services

Employer

Aus Los Angeles Cleanroom

EOR Adjustment Reason

G1 - The charge exceeds the official medical fee schedule allowance. The charge has been adjusted to the scheduled allowance.

Second Review Reason to dispute incorrect reimbursement

Claims administrator incorrectly reduced reimbursement. Per CCR §9795, ML202 reimbursement is $1,316.25. With Modifier 93, the value for the procedure is modified by multiplying the normal value by 1.1, totaling $1,447.88. ML202-93 payment due: $131.63. In addition to payment, penalties and interest are now due.


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