Gonzales, Roger

Dr. Jonathan Macy, an ophthalmology panel QME, evaluated applicant Roger Gonzales and billed Zenith Insurance $2,082.50 for a comprehensive medical-legal evaluation (ML-201), which included $2,015.00 for the ML-201 plus an additional $67.50 billed under CPT code 99199 for clerical costs. Zenith paid the $2,015.00 flat fee but objected to and denied the $67.50, asserting clerical costs are included in the ML-201 flat fee. The cost petitioner argued the additional clerical charge was allowable under Labor Code sections 4620 and 4628(d). The WCJ issued a take-nothing order denying the $67.50, finding clerical costs are inclusive of the ML-201 flat fee under CCR section 9795(b). The Appeals Board adopted and incorporated the WCJ's report and opinion and denied reconsideration, holding that CPT code 99199 is not separately reimbursable because the flat ML-201 fee includes clerical costs of preparing the report.