If you are interested in medical legal billing in California in any capacity, then you need to have a good grasp of the state’s Medical Legal Fee Schedule. In this post, we discuss what the Medical Legal Fee schedule is, plus other useful facts to keep in mind.
What Is the Medical Legal Fee Schedule?
The Medical Legal Fee Schedule (or MLFS for short) is a document where the California Department of Industrial Relations, Division of Workers’ Compensation, sets forth the amounts to be reimbursed for Medical-legal evaluation reports and medical-legal testimony.
The most recent version of the MLFS has been in effect since April 1, 2021, and includes the following fees:
- ML200 – Missed Appointment for a Comprehensive or Follow-Up Medical-Legal Evaluation ($503.75).
- ML201 – Comprehensive Medical-Legal Evaluation ($2,015; Records exceeding 200 pages must be reimbursed at $3.00 per page.).
- ML202 – Follow-up Medical-Legal Evaluation ($1,316.25; Review of records in exceeding 200 pages that were not reviewed as part of the initial comprehensive medical-legal evaluation or as part of any intervening supplemental medical-legal evaluations must be reimbursed at $3.00 per page. ).
- ML203 – Fees for Supplemental Medical-Legal Evaluations ($650; includes review of 50 pages of records. Review of records in excess of 50 pages that were received as part of the request for the supplemental report must be reimbursed at$3.00 per page).
- ML204 – Fees for Medical-Legal Testimony ($455/hr; includes “reasonable preparation” and travel time. The physician must be paid a minimum of two hours for a deposition. If a deposition is canceled fewer than eight (8) calendar days before the scheduled deposition date, the physician shall be paid a minimum of one hour for the scheduled deposition.)
- ML205 – Fees for Review of Sub Rosa Recordings ($325/hr).
- ML-PRR – Record Review ($3.00 per page).
Codes ML201 through ML203 can be accompanied by a modifier, as follows:
- -92 – Performed by a primary treating physician. Added solely for identification purposes only.
- -93 – Interpreter needed at time of examination, or other circumstances which impair communication between the physician and the injured worker and significantly increase the time needed to conduct the examination. Where this modifier is applicable, the value for the procedure is modified by multiplying the normal value by 1.1. Applicable only to ML-201 and ML-202.
- -94 – Evaluation performed by an Agreed Medical Evaluator. Where this modifier is applicable, the value of the procedure is modified by multiplying the normal value by 1. 35. If modifier –93 is also applicable for an ML-201 or ML-202, then the value of the procedure is modified by multiplying the normal value by 1.45.
- -95 – Evaluation performed by a panel selected Qualified Medical Evaluator. Added solely for identification purposes only.
- -96 – Evaluation performed by a Psychiatrist or Psychologist when a psychiatric or psychological evaluation is the primary focus of the medical-legal evaluation. Where this modifier is applicable, the value of the procedure is modified by multiplying the normal value by 2. If modifier -93 is also applicable for an ML-201 or ML-202, then the value of the procedure is modified by multiplying the normal value by 2.10. If modifier -94 is also applicable for an ML-201 or ML-202, then the value of the procedure is modified by multiplying the normal value by 2.35. If both modifier -93 and -94 are also applicable for an ML-201 or ML-202, then the value of the procedure is modified by multiplying the normal value by 2.45.
- -97 – Evaluation performed by a physician who is board certified in Toxicology, a physician who is certified as a Qualified Medical Evaluator in the specialty of Internal Medicine or a physician who is board certified in Internal Medicine, when a Toxicology evaluation is the primary focus of the medical-legal evaluation. Where this modifier is applicable, the value of the procedure is modified by multiplying the normal value by 1.50. If modifier -93 is also applicable for an ML-201 or ML-202, then the value of the procedure is modified by multiplying the normal value by 1.60.
- -98 – Evaluation performed by a physician who is board certified in Medical Oncology, a physician who is certified as a Qualified Medical Evaluator in the specialty of Internal Medicine or a physician who is board certified in Internal Medicine, when an Oncology evaluation is the primary focus of the medical-legal evaluation. Where this modifier is applicable, the value of the procedure is modified by multiplying the normal value by 1.50. If modifier -93 is also applicable for an ML-201 or ML-202, then the value of the procedure is modified by multiplying the normal value by 1.60.
Note that this is just a summary of the MLFS that doesn’t include every possible combination of codes and modifiers. The full text of the Medical Legal Fee Schedule is available online.
To learn more about California’s medical legal fee schedule, we recommend reading some of our previous posts, including:
- Med-Legal Billing Codes in California: A Quick Guide
- California Adopts Rule Allowing Electronic Service of Med-Legal Reports
- 7 Essential Terms To Understand Med.ical Legal Billing in California
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