December 22, 2017

Z.M.S. & Y Acupuncture, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51864(U))

Headnote

The court considered a dispute between Z.M.S. & Y Acupuncture, P.C. and GEICO General Insurance Company regarding the reimbursement for medical services provided. Z.M.S. & Y Acupuncture, P.C. sought to recover first-party no-fault benefits, and GEICO General Insurance Company argued that they had fully paid for the services in accordance with the workers' compensation fee schedule. Specifically, the court focused on the claims for services billed under CPT codes 97810, 97811, 97813, and 97814. The main issues decided were whether the fee schedule was properly applied and whether GEICO General Insurance Company was required to reimburse Z.M.S. & Y Acupuncture, P.C. for the services. The holding of the case was that GEICO General Insurance Company's cross-motion for summary judgment to dismiss the claims for services billed under CPT codes 97811, 97813, and 97814 was granted. The decision was affirmed with modification.

Reported in New York Official Reports at Z.M.S. & Y Acupuncture, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51864(U))

Z.M.S. & Y Acupuncture, P.C. v GEICO Gen. Ins. Co. (2017 NY Slip Op 51864(U)) [*1]
Z.M.S. & Y Acupuncture, P.C. v GEICO Gen. Ins. Co.
2017 NY Slip Op 51864(U) [58 Misc 3d 140(A)]
Decided on December 22, 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This opinion is uncorrected and will not be published in the printed Official Reports.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 December 22, 2017
SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS
PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, MARTIN M. SOLOMON, JJ
2015-451 K C

Z.M.S. & Y Acupuncture, P.C., as Assignee of Melo, Carmen, Respondent,

against

GEICO General Insurance Company, Appellant.

The Law Office of Printz & Goldstein (Lawrence J. Chanice, Esq.), for appellant. Law Offices of Ilona Finkelshteyn, P.C., for respondent (no brief filed).

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered December 17, 2014. 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, 97811, 97813 and 97814.

ORDERED that the order, insofar as appealed from, is modified by providing that 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 97811, 97813 and 97814 are granted; as so modified, the order is affirmed, without costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment, and defendant cross-moved for summary judgment dismissing the complaint on the ground that it had fully paid plaintiff for the services at issue in accordance with the workers’ compensation fee schedule. As to so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810, 97811, 97813 and 97814, the Civil Court, by order entered December 17, 2014, limited the issues for trial, pursuant to CPLR 3212 (g), to the proper application of the fee schedule. Defendant appeals, as limited by its brief, from so much of the order as denied the branches of its cross motion seeking summary judgment [*2]dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810, 97811, 97813 and 97814.

For the reasons stated in Z.M.S. & Y Acupuncture, P.C., as Assignee of Famojuro, Olajumoke v GEICO Gen. Ins. Co. (____ Misc 3d ____, 2017 NY Slip Op ______ [appeal No. 2015-398 K C], decided herewith), the order, insofar as appealed from, is modified by providing that 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 97811, 97813 and 97814 are granted.

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


ENTER:
Paul Kenny
Chief Clerk
Decision Date: December 22, 2017