What Are the Billing Codes for QME Services?
California’s Medical-Legal Fee Schedule (MLFS) uses a concise set of alpha-numeric codes—ML200-series for evaluations and ML400 for testimony—to standardize billing for Qualified Medical Evaluator services. Because fees are flat-rate, accurate code selection is critical: pick the wrong one and you may leave hundreds of dollars unclaimed or trigger a payment dispute.
The Core Medical-Legal Codes
| Code | Purpose | 2025 Fee* |
|---|---|---|
| ML200 | Comprehensive medical-legal evaluation (initial or new injury) | $2,015 |
| ML201 | Follow-up evaluation (re-examination within 18 mos.) | $1,316 |
| ML202 | Supplemental report—no re-exam, new information only | $650 |
| ML203 | Missed/late cancellation (less than 6 business days’ notice) | $503 |
| ML204 | Face-to-face time-based service (rare; psychiatric/complex) | $273 per 15 min |
| ML400 | Deposition or trial testimony | $325 per hour |
*Fees reflect the 2024–25 schedule; verify annually for CPI adjustments.
Common Modifiers & Add-Ons
- -B — Billing for record review: $3.00 per page in 15-minute increments (applies to ML200, ML201, ML202).
- -C — Complex/extraordinary circumstances: +25 % when the evaluator addresses three or more body parts, psych overlay, or toxic exposure.
- -LC — Language complexity: +10 % when certified translation is required.
How to Select the Correct Code
- Is this the first time you’ve evaluated this claim or body part? ➜ ML200
- Did you physically re-examine the worker within 18 months of your last eval? ➜ ML201
- Were you asked only to review new records or answer clarifying questions? ➜ ML202
- Did the worker cancel with fewer than 6 business days’ notice? ➜ ML203
- Are you providing time-based, face-to-face psych or multi-hour complex evaluation? ➜ ML204
After selecting the base code, add the appropriate modifiers for record-review hours, complexity, or translation. List each modifier on the invoice line and include a brief narrative justification (e.g., “–B, 1.5 hrs review, 450 pages”).
Where to Find the Official Fee Schedule
The complete MLFS—including definitions, fee tables, and modifier rules—appears in California Code of Regulations, Title 8, §9795. Download the current PDF from the DWC site: Medical-Legal Fee Schedule (§9795).
Mastering these codes ensures you capture full compensation and withstand audit scrutiny—an essential step toward a profitable, compliant QME practice.