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ML201 - State Compensation Insurance Fund (CA): Grade F

ML201 - State Compensation Insurance Fund (CA): Grade F

Claims administrator failed to properly reimburse ML201. State Compensation Insurance Fund (CA) incorrectly denied valid medical-legal codes as “not compensable.” Date of Service: 04/07/2021

MLFS Code(s)

ML201 - Comprehensive Medical-Legal Evaluation

MLFS Modifier(s)

92 - Performed by a primary treating physician

93 - Interpreter needed at time of examination

MLFS Grade

F

Claims Administrator

State Compensation Insurance Fund (CA)

Bill Review Vendor

State Compensation Insurance Fund (CA)

Employer

Real Plants, Inc.

EOR

Adjustment Reason

M1 - Workers' compensation claim adjudicated as non-compensable. Carrier not liable for claim or service/treatment.

Second Review Reason to dispute incorrect reimbursement:

Claims administrator incorrectly 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. ML201-92-93 payment due: $2,216.50. In addition to payment, penalties and interest are now due.


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