Can I Bill for Missed QME Appointments?
Yes—California’s Medical-Legal Fee Schedule expressly authorizes reimbursement when an injured worker fails to attend a scheduled Qualified Medical Evaluator examination. The applicable code is ML203, and it covers “missed, late-cancellation, or no-show” events, provided you follow the timing and documentation rules set by the Division of Workers’ Compensation (DWC).
When ML203 Applies
- No-show: The worker simply does not appear at the appointed time.
- Late cancellation: The worker (or attorney) cancels with fewer than six business days’ notice.
- Late arrival causing rescheduling: The claimant arrives so late that you cannot complete the exam that day.
A cancellation received ≥ 6 business days before the exam is not billable under ML203.
How Much You Can Bill
• ML203 flat fee: $503 (2024-25 schedule)
• No record-review or complexity modifiers are added—even if you already reviewed records.
Billing & Documentation Requirements
- Issue a “Proof of Non-Attendance.” Briefly state the appointment date, time, location, and that the claimant failed to appear or cancelled late.
- Invoice with ML203 code. Include the flat fee and serve the invoice on all parties and the claims administrator.
- Keep contemporaneous notes. Document the exact arrival/cancellation time and attach any voicemail or e-mail evidence.
Timeliness of Payment
The claims administrator must pay within 60 days of receiving your ML203 invoice. If payment is late, you may add the statutory 10 % penalty and interest per Labor Code §4622.
Best Practices to Minimize No-Shows
- Send confirmation letters 14 days before the exam, reiterating date, time, and no-show fee.
- Call or text reminders 48 hours prior—many evaluators see a 30 % drop in no-shows with this simple step.
- Offer a remote video option when clinically appropriate (e.g., psych evaluations) to reduce travel-related cancellations.
For the official ML203 description and current fee, refer to the Medical-Legal Fee Schedule (§ 9795).