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ML201 - Helmsman Management Services: Grade F

ML201 - Helmsman Management Services: Grade F

Claims administrator failed to properly reimburse ML201. Helmsman Management Services incorrectly reduced reimbursement by failing to process code with Modifier 93. Date of Service: 04/02/2021

MLFS Code(s)

ML201 - Comprehensive Medical-Legal Evaluation

MLFS Modifier(s)

93 - Interpreter needed at time of examination

MLFS Grade

F

Claims Administrator

Helmsman Management Services

Bill Review Vendor

Helmsman Management Services

Employer

ADP TotalSource Group

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. ML201-93-95 payment due: $201.50 In addition to payment, penalties and interest are now due.


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