Key Takeaway
Expert legal guidance on ROM and MM testing billing disputes for Long Island and NYC healthcare providers. Navigate inconsistent court decisions and maximize reimbursements. Call 516-750-0595.
Introduction
Healthcare providers in Long Island and New York City face ongoing challenges when dealing with no-fault insurance claims, particularly regarding range of motion (ROM) and manual muscle (MM) testing billing. The inconsistent legal opinions surrounding fee-schedule denials create uncertainty for medical practices seeking proper reimbursement for legitimate services. Understanding these complexities is crucial for providers navigating the intricate landscape of New York’s no-fault insurance system.
The cases discussed below highlight the critical importance of staying informed about billing practices and legal precedents that can significantly impact your practice’s revenue and compliance with New York State regulations.
Understanding Range of Motion and Manual Muscle Testing Billing
Legal Precedent and Court Decisions
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 ).”
Compare, First Aid Occupational Therapy, PLLC v Country-Wide Ins. Co., 2010 NY Slip Op 50149(U)(App. Term 2d Dept. 2010).
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.
The Problem of Inconsistent Court Decisions
Why Inconsistency Matters for Long Island and NYC Providers
The legal landscape surrounding ROM and MM testing billing presents unique challenges for healthcare providers throughout Long Island and New York City. When courts reach different conclusions on identical facts, it creates uncertainty that can severely impact practice management decisions and revenue projections.
These inconsistencies affect providers in several ways:
- Billing Strategy Uncertainty: Providers cannot rely on consistent legal precedent when developing billing strategies
- Resource Allocation: Uncertainty makes it difficult to allocate resources for billing disputes and litigation
- Training Challenges: Staff training becomes complicated when legal standards vary between jurisdictions
- Financial Planning: Revenue forecasting becomes nearly impossible with inconsistent reimbursement outcomes
The Technical Aspects of ROM and MM Testing
Understanding the technical differences between ROM and MM testing is crucial for proper billing and avoiding denials:
Range of Motion (ROM) Testing:
- Measures the extent of movement possible at a joint
- Can be performed on multiple body sections
- Billable per body section examined
- Subject to medical necessity requirements
- Must be properly documented with specific measurements
Manual Muscle (MM) Testing:
- Evaluates the strength of individual muscles or muscle groups
- Limited to specific CPT codes (95833 or 95844)
- Cannot be billed multiple times for different body parts
- Requires one unit billing regardless of body parts tested
- Must demonstrate medical necessity for the examination
Impact on Long Island Healthcare Practices
Regional Considerations
Long Island healthcare providers face unique challenges due to the high volume of motor vehicle accidents in the region. The Long Island Expressway, Northern and Southern State Parkways, and numerous busy local roads contribute to a steady stream of no-fault insurance claims requiring ROM and MM testing.
Nassau and Suffolk County providers must be particularly vigilant about:
- High claim volume: More accidents mean more potential billing disputes
- Insurance company scrutiny: Higher volume leads to increased scrutiny from carriers
- Regional legal precedents: Local court decisions may vary from NYC precedents
- Competition: High provider density increases competition and billing pressure
New York City Market Dynamics
NYC healthcare providers operate in an even more complex environment with:
- Multiple court jurisdictions: Different boroughs may have varying interpretations
- Diverse insurance carrier presence: More carriers mean more varied policies
- Higher regulatory oversight: Increased state attention to fraud prevention
- Complex referral networks: More complicated billing relationships
Frequently Asked Questions
What should I do if my ROM/MM testing claims are denied?
When facing denials for ROM or MM testing claims, immediately review the denial reason and compare it against current legal precedents. Document all testing performed, ensure proper CPT coding, and consider appealing with supporting legal citations.
How can I protect my practice from inconsistent court decisions?
Stay informed about recent court decisions, maintain detailed documentation for all testing procedures, ensure staff are trained on current billing requirements, and consider consulting with healthcare attorneys familiar with no-fault billing issues.
What’s the difference between billing ROM and MM testing?
ROM testing can be billed per body section examined, while MM testing is limited to one unit regardless of how many body parts are tested. MM must use CPT codes 95833 or 95844, not 95831 multiplied by body parts.
Should I continue providing these services despite billing uncertainties?
These are legitimate, compensable medical services when medically necessary. The key is proper documentation, correct coding, and staying informed about legal developments that may affect reimbursement.
How do I handle requests for additional documentation?
Respond promptly to all requests for additional documentation. Provide comprehensive records showing medical necessity, proper examination techniques, and detailed findings for all testing performed.
Best Practices for Long Island and NYC Providers
Documentation Standards
Proper documentation is your best defense against denials:
- Detailed examination notes: Record specific measurements and findings
- Medical necessity justification: Clearly explain why testing was required
- Treatment plan integration: Show how results inform treatment decisions
- Progress tracking: Document improvements or changes over time
- Patient compliance: Note patient cooperation and effort during testing
Billing Compliance
Ensure your billing practices align with current regulations:
- Regular training updates: Keep billing staff current on coding changes
- Quality assurance reviews: Regularly audit claims before submission
- Legal consultation: Maintain relationships with healthcare law attorneys
- Industry networking: Stay connected with other providers facing similar issues
The Future of ROM and MM Testing Billing
Regulatory Developments
New York State continues to refine no-fault regulations, and providers should monitor:
- Proposed regulation changes: Stay informed about pending regulatory updates
- Court decision trends: Track how courts are interpreting billing requirements
- Insurance carrier policies: Monitor changes in carrier reimbursement practices
- Technology integration: Consider how electronic health records affect documentation
Adaptation Strategies
Successful practices will adapt by:
- Investing in technology: Better documentation systems and billing software
- Enhanced training programs: Regular education for clinical and billing staff
- Legal partnerships: Maintaining relationships with experienced healthcare attorneys
- Peer collaboration: Working with other providers to share best practices
- Continuous improvement: Regular review and refinement of billing processes
Contact Our Experienced No-Fault Legal Team
Navigating the complexities of ROM and MM testing billing requires experienced legal guidance. Our team understands the nuances of New York’s no-fault insurance system and can help protect your practice’s revenue while ensuring compliance with all applicable regulations.
Call us today at 516-750-0595 for a consultation about your no-fault billing challenges. We provide comprehensive legal support to healthcare providers throughout Long Island and New York City, helping you maximize legitimate reimbursements while minimizing legal risks.
Don’t let inconsistent court decisions impact your practice’s financial health. Contact us to discuss how we can help you navigate these complex billing issues and protect your practice’s interests in an ever-evolving legal landscape.
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Legal Update (February 2026): Since this 2010 post, New York’s no-fault fee schedules and reimbursement regulations have undergone multiple revisions, including amendments to allowable charges for diagnostic testing and manual therapy services. Additionally, procedural requirements for fee schedule denials and appeals processes may have been modified through regulatory updates and subsequent court decisions. Practitioners should verify current fee schedule provisions and recent case law developments regarding range of motion and manual muscle testing billing practices.
