ML201 - Athens Administrators: Grade F
Claims administrator failed to properly reimburse ML201. Athens incorrectly reduced reimbursement by failing to adjudicate service with Modifier 93. Date of Service: 04/14/2021
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 |
Athens Administrators |
Bill Review Vendor |
Genex |
Employer |
Southern California Pizza Company, 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: $201.50. In addition to payment, penalties and interest are now due. |
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