Key Takeaway
Appellate Term ruling creates triable issue of fact regarding separate reimbursement for range of motion testing versus inclusion in office visit services.
New York’s no-fault insurance system frequently generates disputes over what medical services qualify for separate reimbursement versus those considered bundled within other procedures. One particularly contentious area involves range of motion testing and whether insurers can deny these claims by arguing they’re already included in office visit fees. This ongoing debate affects healthcare providers across the state who perform these diagnostic assessments as part of treating accident victims.
The Appellate Term’s decision in First Aid Occupational Therapy, PLLC v Country-Wide Ins. Co. illustrates how courts approach these fee schedule disputes when both parties present competing arguments about service bundling. Understanding these rulings helps clarify the evolving standards for what constitutes separately reimbursable services under New York’s no-fault regulations.
Jason Tenenbaum’s Analysis:
First Aid Occupational Therapy, PLLC v Country-Wide Ins. Co., 2010 NY Slip Op 50594(U)(App. Term 2d Dept. 2010)
“Defendant also established that it had timely denied the two $182.84 and three $523.20 claims on the ground that the services for which payment was sought were part of another service and, thus, were not separately reimbursable (see St. Vincent Med. Care, P.C. v Country-Wide Ins. Co., 26 Misc 3d 58 ), and defendant’s opposition papers were sufficient to raise a triable issue of fact with respect thereto. Consequently, neither party was entitled to summary judgment on the first, seventh and eighth causes of action, as well as so much of the third cause of action as sought to recover upon the $523.20 claim.”
I have posted on this issue previously. Again, I do not generally believe that the range of motion testing is included in the office visit as the insurance carrier has been arguing in these cases.
Key Takeaway
This Appellate Term decision demonstrates the ongoing uncertainty surrounding range of motion testing reimbursement in no-fault cases. While insurance carriers frequently argue these services are bundled with office visits, the court’s recognition of a triable issue of fact suggests the matter remains unsettled, requiring case-by-case analysis rather than blanket denials.
Related Articles
- New York No-Fault Insurance Law
- Understanding competent evidence requirements for fee schedule defenses
- Fee schedule defense requirements in no-fault insurance cases
- Medical billing and down-coding practices in no-fault claims
- How Civil Court JHOs can reverse Appellate Division holdings in no-fault cases
Legal Update (February 2026): Since this 2010 decision, New York’s no-fault fee schedules and reimbursement methodologies have undergone multiple revisions, including updates to procedure codes, bundling guidelines, and rate structures. Healthcare providers and attorneys should verify current fee schedule provisions and recent appellate decisions regarding range of motion testing compensability, as both regulatory amendments and evolving case law may have modified the standards discussed in this analysis.
