Free Med-Legal Q&A Webinar! Join us on October 27, 1-2pm PT
ML200 - Sedgwick Claims Management Services: Grade F

ML200 - Sedgwick Claims Management Services: Grade F

Claims administrator failed to properly reimburse ML200. Sedgwick incorrectly denied valid medical-legal code as “not considered a valid reimbursable code.” Date of Service: 04/02/2021

MLFS Code(s)

ML200 - Missed Appointment for a Comprehensive or Follow-Up Medical-Legal Evaluation

MLFS Modifier(s)

95 - Evaluation performed by a panel selected Qualified Medical Evaluator

MLFS Grade


Claims Administrator

Sedgwick Claims Management Services

Bill Review Vendor

Sedgwick CMS National Bill Review


Express Services, Inc.


Adjustment Reason

561 - According to the state fee schedule, this procedure code is not considered a valid reimbursable code. Please re-submit with a valid code.

Second Review Reason to dispute incorrect reimbursement

Claims administrator incorrectly denied reimbursement. Per CCR §9795, ML200 is a valid code with a Relative Value of 31. Missed appointments are reimbursable when the injured worker fails to appear for the evaluation appointment. ML200-95 payment due: $503.75. In addition to payment, penalties and interest are now due.

View All MLFS Report Cards

Subscribe to DaisyNews

Recent Posts

Popular Topics

California (515) claims administrators Billing Education News Updates Fee Schedule OMFS Second Review California DWC e-Billing RFA medical-legal
New York (5) CMS 1500 Billing Education Electronic Billing e-Billing