ML201 - Liberty Mutual Insurance: Grade F
Claims administrator failed to properly reimburse ML201. Liberty Mutual incorrectly reduced reimbursement by failing to process code with Modifiers 93 and 94. Date of Service: 04/08/2021
MLFS Code(s) |
ML201 - Comprehensive Medical-Legal Evaluation |
MLFS Modifier(s) |
93 - Interpreter needed at time of examination 94 - Evaluation performed by an Agreed Medical Evaluator |
MLFS Grade |
F |
Claims Administrator |
Liberty Mutual Insurance |
Bill Review Vendor |
Liberty Mutual Insurance |
Employer |
Colletta Carpet Cleaning |
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 and 94, the value for the procedure is modified by multiplying the normal value by 1.45, totaling $2,921.75. ML201-93-94 payment due: $906.75. In addition to payment, penalties and interest are now due. |
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