Today’s issue of WorkCompRecap features the release of a new report from CWCI that found payments for medical-legal services used to resolve medical disputes over compensability issues in California have risen sharply under the new Medical-Legal Fee Schedule (MLFS) that took effect in April 2021.
Key findings from the report included that replacing the three levels of evaluations with a single comprehensive evaluation reimbursed at a flat fee of $2,015 likely had the biggest impact on average payments. Basic evaluations accounted for about 40% of the evaluations paid under the new comprehensive service code, and the new flat fee increased the payment for those services by 222%. More complex evaluations represented 18% of the new evaluations, with payments for them increasing 115%. Additionally, compared to the same period in 2019, the average payment for a comprehensive evaluation that includes a face-to-face exam of the injured worker rose 52.9%, and the average payment for a supplemental evaluation rose 39.1%.