New Rules Governing Payment For Medical-Legal Evaluations

On April 1, 2021, new rules took effect that will result in a significant increase in the cost of the medical-legal evaluations, testimony, sub-rosa reviews, and record review: Title 8, California Code of Regulations §§ 9793, 9794, & 9795. Prior to the new legislation, there was a fee schedule whereby the physician would bill hourly under ML-104 depending on the complexity of the case. This fee schedule will apply to those who sent evaluation applications to the AME or QME prior to April 1st of this year.

The goal of the new legislation is to improve the delivery of medical-legal evaluations and deter abuse of the prior fee schedule. The new flat fee schedule creates a set amount for the various services:

• $2,015 for an initial evaluation, which includes 200 pages for review and $3.00 per page thereafter.
• $1,316.25 for a re-evaluation within 18 months of the prior exam, which includes review of an additional 200 pages and $3.00 per page thereafter.
• $650 for a supplemental report, which includes review of up to 50 pages not previously reviewed by the evaluator and $3.00 per page thereafter.

Additionally, there are further multipliers that increase the basic fee for various reasons including the addition of an interpreter, AME exams, psych QMEs, and toxicology and oncology exams. However, the $3.00 per page charge does not increase. Depositions are also included in the new rules, being billed at $455 per hour with a 2-hour minimum and doctors now entitled to one hour of deposition time if the deposition is cancelled within eight calendar days.

Pearlman, Brown, and Wax is instituting new policies and procedures that proactively ensure cost savings and the efficient execution of legislation requirements for their clients. Contact your Pearlman, Brown, and Wax legal advisor to learn more about the new rules and the future legislation proceedings.