St. Vincent Med. Care, P.C. v Country-Wide Ins. Co., 2010 NY Slip Op 50444(U)(App. Term 2d Dept. 2010)
“Defendant also established that it had timely denied the two $365.68 claims (plaintiff’s fourth and seventh causes of action) on the ground that the services for which payment was sought were part of another service and, thus, were not separately reimbursable. Consequently, defendant raised a triable issue of fact with respect to the fourth and seventh causes of action (see St. Vincent’s Med. Care, P.C. v Country-Wide Ins. Co., ___ Misc 3d ___, 2009 NY Slip Op 29508 [App Term, 2d, 11th & 13th Jud Dists 2009]).”
Compare, First Aid Occupational Therapy, PLLC v Country-Wide Ins. Co., 2010 NY Slip Op 50149(U)(App. Term 2d Dept. 2010), which I discussed here.
Same facts, yet different result than that found in First Aid Occupational Therapy, PLLC.
Range of Motion (ROM) and Manual muscle (MM) testing are compensable services, and the argument raised in the above cases lacks merit. What you must understand, however, is that MM is limited to being billed as one unit at either CPT Code 95833 or CPT Code 95844. It cannot be billed at 95831 * each body part. ROM is per body section, and can be billed numerous times, subject to other collateral issues that are out there. You can contact me if you want my other thoughts.
