MLFS Code(s)

ML201 - Comprehensive Medical-Legal Evaluation

MLFS Modifier(s)

95 - Evaluation performed by a panel selected Qualified Medical Evaluator

93 - Interpreter needed at time of examination

MLFS Grade

F

Claims Administrator

AmTrust North America

Bill Review Vendor

Mitchell International

Employer

JEM Venture LLC

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, ML201 reimbursement is $2,015. With Modifier 93, the value for the procedure is modified by multiplying the normal value by 1.1, totaling $2,216.50. ML201-95-93 payment due: $1,591.50. In addition to payment, penalties and interest are now due.