ML201 - Farmers Insurance: Grade F

ML201 - Farmers Insurance: Grade F

Claims administrator failed to properly reimburse ML201. Farmers incorrectly re-coded ML201 to ML103. Date of Service: 04/05/2021

MLFS Code(s)

ML201 - Comprehensive Medical-Legal Evaluation

MLFS Modifier(s)

93 - Interpreter needed at time of examination

95 - Evaluation performed by a panel selected Qualified Medical Evaluator

MLFS Grade

F

Claims Administrator

Farmers Insurance

Bill Review Vendor

Mitchell International

Employer

Laselva Designs LLC

EOR Adjustment Reason

270 - Please resubmit the bill with new ML codes with documentation and SBR for reconsideration.

Second Review Reason to dispute incorrect reimbursement

Claims administrator incorrectly re-coded ML201 to ML103 and denied reimbursement. Per CCR §9795, ML201 is valid reimbursable procedure code that includes all comprehensive medical-legal evaluations that do not qualify as follow-up or supplemental medical- legal evaluations. Provider conducted a Comprehensive Medical-Legal Evaluation at the request of the parties. ML201-93-95 payment due: $2,216.50. In addition to payment, penalties and interest are now due.


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