November 16, 2018

Acupuncture Now, P.C. v GEICO Ins. Co. (2018 NY Slip Op 51647(U))

https://www.beynensonlaw.com/case-law/acupuncture-now-p-c-v-geico-ins-co-2018-ny-slip-op51647u/

Court: Appellate Term, Second Department
Decided: November 16, 2018
Citation: 2018 NY Slip Op 51647(U) · 61 Misc 3d 143(A)
Posture: Summary judgment
Outcome: Insurer prevailed
Issues: Fee schedule
Legal questions: Proving a fee schedule defense (see the maps)

Cite as

Acupuncture Now, P.C. v GEICO Ins. Co., 61 Misc 3d 143(A), 2018 NY Slip Op 51647(U) (App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2018)

Posture, outcome, issues and treatment by other decisions are Beynenson Law’s classification. Treatment labels are assigned by a language model reading the citing decision; negative and appeal-history labels are checked by a second reader.

Summary

Editorial summary by Beynenson Law, not part of the court’s decision.

The insurer's cross motion for summary judgment on the fee-schedule defense to claims billed under CPT codes 97810 and 97811 was granted on appeal. The Appellate Term, Second Department, reversed the Civil Court, Kings County, order, insofar as appealed from, and dismissed those claims for the reasons stated in the companion appeal decided the same day, No. 2016-1377 K C.

Reported in New York Official Reports at Acupuncture Now, P.C. v GEICO Ins. Co. (2018 NY Slip Op 51647(U))

[*1]

Acupuncture Now, P.C. v GEICO Ins. Co.

2018 NY Slip Op 51647(U) [61 Misc 3d 143(A)]

Decided on November 16, 2018

Appellate Term, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on November 16, 2018

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2016-1459 K C

Acupuncture Now, P.C., as Assignee of Merkison, Douglas, Respondent,
against
GEICO Ins. Co., Appellant.

Law Office of Goldstein & Flecker (Lawrence J. Chanice of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered April 14, 2016. The order, insofar as appealed from and as limited by the brief, denied the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810 and 97811.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810 and 97811 are granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its brief, from so much an order of the Civil Court as denied the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810 and 97811 on the ground that the amounts plaintiff sought to recover, for services rendered prior to April 1, 2013, were in excess of the workers’ compensation fee schedule.

For the reasons stated in Acupuncture Now, P.C., as Assignee of Carlos, Illingworth v GEICO Ins. Co. (__ Misc 3d ___, 2018 NY Slip Op _____ [appeal No. 2016-1377 K C], decided herewith), the order, insofar as appealed from, is reversed, and the branches of defendant’s cross [*2]motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810 and 97811 are granted.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 16, 2018

Legal questions

A question of no-fault law this decision rules on, from our Legal Questions pages. Bars count the decisions on the question by year and court, coloured by category; circles are this decision and the decisions on the question it cites or that cite it. Point at a bar or circle for details. The categories and summaries are Beynenson Law’s classification, made by a language model and checked by a second reading.

Proving a fee schedule defense

Open the full map

Did the insurer prove that the amount billed exceeded the applicable workers’ compensation fee schedule?

This decision: Insurer proved the billed amount exceeded the applicable fee schedule

Granted the insurer summary judgment dismissing the claims for the acupuncture codes on the ground that the amounts sought exceeded the workers' compensation fee schedule, for the reasons given in a companion appeal.

Excess shownNot established; openDefense rejectedSplit by chargeThis decision

Of the 285 decisions on this question in the Second Department courts and the Court of Appeals, 147 (this one included) are in the same category.

Similar decisions

Oleg’s Acupuncture, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51863(U))The insurer established full payment under the chiropractic acupuncture fee schedule for services billed under CPT codes 97813 and 97814.
Z. M. S. & Y Acupuncture, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51891(U))A fee-schedule defense is not subject to preclusion for services rendered after April 1, 2013, under 11 NYCRR 65-3.8 (g).
BQE Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51803(U))The insurer's cross motion for summary judgment dismissing the provider's complaint was granted on appeal.
UGP Acupuncture, P.C. v GEICO Ins. Co. (2022 NY Slip Op 50612(U))The insurer's fee-schedule summary judgment dismissing acupuncture claims under CPT codes 97810 and 97811 was affirmed.
Natural Therapy Acupuncture, P.C. v GEICO Ins. Co. (2019 NY Slip Op 51254(U))The insurer established that its payments complied with the workers' compensation fee schedule, and the provider failed to rebut that showing.