How Are QMEs Paid in California?
Qualified Medical Evaluators are reimbursed under a state-mandated Medical-Legal Fee Schedule. Unlike traditional health-insurance billing, payment is flat-rate and tied to service type, so you know your revenue before you write the report.
The Core Billing Codes
The majority of QME earnings come from three medical-legal codes:
- ML200 – Comprehensive Evaluation
• Base fee: $2,015
• Used for first-time, full impairment evaluations.
• Modifiers add compensation for additional body parts, complex causation analysis, and record review time. - ML204 – Supplemental Report
• Flat fee: $650.
• Covers clarifications or new records that do not require a re-examination. - ML400 – Deposition or Trial Testimony
• Hourly rate: $325, portal-to-portal.
• One-hour minimum; billed in 15-minute increments thereafter.
Record-Review and Complexity Modifiers
California allows you to bill $3.00 per page for record review, applied in ¼-hour units, once a base threshold of 200 pages is exceeded. Complexity add-ons—such as poly-trauma, psych overlay, or language translation—can raise total reimbursement by 25–50%.
Invoicing Mechanics
- Attach an itemized invoice to the report, listing code, modifiers, record-review time, and total fee.
- Serve the invoice with the report to all parties and the claims administrator.
- Retain proof of service; payment disputes hinge on the service date.
Payment Timelines and Penalties
The claims administrator must remit payment within 60 days of receiving your invoice (Labor Code §4622). If payment is late or under-paid, you may demand penalties of up to 10% plus interest. A second notice of non-payment often resolves the issue without litigation.
Electronic vs. Paper Billing
While the DWC does not mandate electronic invoicing, many QMEs use secure e-mail portals or billing services to expedite processing and obtain electronic proof-of-receipt—helpful if penalties become necessary.
Expense Snapshot
Net revenue remains high because overhead is minimal—no CPT coding battles, no prior authorizations, and malpractice carriers rarely add surcharges for medical-legal work.
For the official fee tables, modifiers, and billing rules, consult California’s Medical-Legal Fee Schedule (§9795).