September 8, 2017
Charles Deng Acupuncture, P.C. v ELRAC, Inc. (2017 NY Slip Op 51149(U))
https://www.beynensonlaw.com/case-law/charles-deng-acupuncture-p-c-v-elrac-inc-2017-ny-slip-op-51149u/
- Court
- Appellate Term, Second Department
- Decided
- September 8, 2017
- Citation
- 2017 NY Slip Op 51149(U) · 57 Misc 3d 127(A)
- Posture
- Summary judgment
- Outcome
- Insurer prevailed
- Issues
- Fee schedule
- Legal questions
- Proving a fee schedule defense (see the maps)
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.
Reported in New York Official Reports at Charles Deng Acupuncture, P.C. v ELRAC, Inc. (2017 NY Slip Op 51149(U))
[*1]| Charles Deng Acupuncture, P.C. v ELRAC, Inc. |
| 2017 NY Slip Op 51149(U) [57 Misc 3d 127(A)] |
| Decided on September 8, 2017 |
| 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| This opinion is uncorrected and will not be published in the printed Official Reports.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 September 8, 2017
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M. SOLOMON, JJ
&em;
against
ELRAC, Inc., Respondent.
The Rybak Firm, PLLC (Joseph D. DePalma, Esq.), for appellant. Carman, Callahan & Ingham, LLP (Jeffrey P. Saxon, Esq.), for respondent.
Appeal from an order of the Civil Court of the City of New York, Queens County (William A. Viscovich, J.), entered July 1, 2014. The order, insofar as appealed from, granted the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover for services billed under CPT codes 97810 and 97811.
ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.
In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from so much of an order of the Civil Court as granted the branches of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover for services billed under CPT codes 97810 and 97811.
Plaintiff argues that defendant failed to establish that defendant’s fee reductions, which had been done in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors, were proper. However, this court has held, “as a matter of law, that an insurer may use the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to [*2]receive for such acupuncture services” (Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23, 24 [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2009]).
Accordingly, the order, insofar as appealed from, is affirmed.
PESCE, P.J., ALIOTTA and SOLOMON, JJ., concur.
Paul Kenny
Chief Clerk
Decision Date: September 08, 2017
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.
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
Upheld dismissal of the acupuncture codes because the insurer may, as a matter of law, pay a licensed acupuncturist at the chiropractor acupuncture fee schedule rate, which it had applied.
Of the 284 decisions on this question in the Second Department courts and the Court of Appeals, 147 (this one included) are in the same category.
Cited in this decision
A label shows how this decision treated the case it cites.
- Great Wall Acupuncture, P.C. v Geico Ins. Co. (2009 NY Slip Op 29467) FollowedAn insurer may use the chiropractic acupuncture fee schedule to reimburse acupuncture services performed by a licensed acupuncturist.
Similar decisions
- Charles Deng Acupuncture, P.C. v 21st Century Ins. Co. (2017 NY Slip Op 51252(U))An insurer may use the chiropractors' acupuncture fee schedule to determine reimbursement for a licensed acupuncturist's services.
- UGP Acupuncture, P.C. v 21st Century Ins. Co. (2018 NY Slip Op 51657(U))An insurer may use the workers' compensation fee schedule for chiropractors' acupuncture to reimburse a licensed acupuncturist.
- Charles Deng Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2017 NY Slip Op 51460(U))The insurer established full payment for CPT codes 97810 and 97811 under the workers' compensation fee schedule for chiropractors' acupuncture.
- BQE Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co. (2019 NY Slip Op 51260(U))An insurer may use the workers' compensation fee schedule for acupuncture by chiropractors to reimburse a licensed acupuncturist.
- Health Needles Acupuncture, P.C. v GEICO Ins. Co. (2014 NY Slip Op 51864(U))The insurer established full payment for the disputed acupuncture services under the workers' compensation fee schedule for chiropractors.