Key Takeaway
Court case analysis examining chiropractor MUA billing disputes under NY no-fault fee schedules, including rate limitations and multiple procedure rules.
Flatbush Chiropractic, P.C. v Metlife Auto & Home, 2012 NY Slip Op 50541(U)(Civ. Ct. Kings Co. 2012).
The Plaintiff, Dr. Super’s brother runs a law firm about 2 floors up from me in my building here in Garden City. His firm probably handles the lion’s share of his MUA enterprise. I had a conversation with one of the attorneys who told me that Dr. Super does not believe in the fee schedule for MUA. Civil Kings, true to form, never surprises me.
There are three passages from this case that intrigue me. I am ignoring the medical necessity portion of this opinion because that is a whole different issue.
Passage one: “Defendant’s claims examiner testified that pursuant to the Workers Compensation Board chiropractors should only be compensated at a rate of 68.4% of the Fee Schedule. Through the testimony of Dr. Super, Plaintiff refuted this position stating that the Fee Schedule makes no such distinction.”
Passage two: “The Court takes judicial notice of an opinion letter (dated August 14, 2009) from Kenneth J. Munnelly, General Counsel of the Workers’ Compensation Board, which concludes that chiropractors who perform MUAs should be compensated at a rate of 68.4% of the allowable rate for medical doctors who perform the same procedure given the relative experience and training of a medical doctor versus that of a licensed chiropractor.”
So, now that it has been established that Dr. Super is greedy, you would think it would end here. Nope.
Passage three: “Also at issue was the applicability of Ground Rules 5 and 12 of the Fee Schedule. Ground Rule 5, the multiple procedure rule, stands for the proposition that when multiple procedures are performed payment for the first procedure is paid at 100% and payment for additional procedures is reduced by 50%. Ground Rule 12(d), which Defendant applied, covers the apportionment of payment between two attending surgeons. Here, Defendant reduced Plaintiff’s bill according to Ground Rules 5 and 12. Plaintiff argued that Ground Rule 5 does not apply to MUAs because MUAs of the shoulders, hips, and cervical, thoracic, and lumbar spine are each distinct, stand-alone procedures involving separate body parts and as a result it was not appropriate to reduce payment pursuant to Ground Rule 5. Dr. Super compared MUAs to regular chiropractic manipulation procedures, where each part of the spine is billed as a separate and distinct procedure. Dr. Super also stated that Ground Rule 12 does not apply because according to the “Introduction and General Guidelines” of the Fee Schedule and Modifier 62, each chiropractor is entitled to separate and full [*4]payment for their services when two chiropractors work together as primary chiropractors and perform distinct parts of a procedure. Dr. Super maintained that both he and Dr. Klass are entitled to 100% of the fee billed because MUA guidelines require MUAs to be performed by two doctors, and here both he and Dr. Klass were co-attending chiropractors who each performed co-primary functions throughout the MUAs which entitled them each to full payment for the procedures independent of each other.The Court agrees and credits Dr. Super’s testimony and finds that the Plaintiff did not bill in excess of the Fee Schedule. Dr. Super has performed and billed MUAs for the past thirteen years. He was trained in the Fee Schedule by certified coding experts and has conducted research on the Fee Schedule in order to ensure that he bills according to the services performed and pursuant to the Fee Schedule. As the treating chiropractor, Dr. Super is in the best position to assess the treatment rendered and bill accordingly. Dr. Super’s testimony that each of the MUAs he performed are separate and distinct procedures coupled with the fact that MUA guidelines mandates two chiropractors justifies full compensation for each chiropractor.”
It is comical. The court established that Dr. Super does not acknowledge the validity of the fee schedule and trims down his billing by about 50% at least. After this, the Court finds Dr. Super to be a coding expert and allows him to ignore the 50% ground rule and multiple surgeon ground rule.
Falso in uno, falso in omnibis? PJI 1:75 anyone?
Just remember this adage: “Pigs get fat and hogs get slaughtered.”
Related Articles
- Chiropractor rate limitations and fee schedule defenses
- Fee schedule defense requirements and competent evidence standards
- Medical billing practices and down-coding in no-fault claims
- Civil Court decisions challenging appellate precedent on fee schedules
- New York No-Fault Insurance Law
Legal Update (February 2026): The Workers’ Compensation Board fee schedule provisions and reimbursement rates referenced in this 2012 post have likely undergone multiple revisions since publication. Practitioners should verify current fee schedule percentages for chiropractic services, particularly regarding MUA procedures and any applicable differential rates between provider types, as these provisions are subject to periodic regulatory updates.
