Key Takeaway
Suffolk County District Court rules on 8-unit billing limit for medical providers under NY no-fault insurance fee schedule, allowing reimbursement despite multiple claims.
This article is part of our ongoing fee schedule coverage, with 118 published articles analyzing fee schedule issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
Doctor of Medicine in the House, P.C. v Allstate Ins. Co., 2013 NY Slip Op 23357 (District Ct. Suffolk Co. 2013)
“Paragraph 11 of the New York Compensation Medical Fee Schedule provides:
Multiple Physical Medicine Procedures and Modalities:
When multiple physical medicine procedures and/or modalities are performed on the same day, reimbursement is limited to 8.0 units or the amount billed, whichever is less. The following codes represent the physical medicine procedures and modalities subject to this rule…”
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“The purpose of the Workers’ Compensation Medical Fee Schedule is to prevent “excessive billing” by each individual provider and not to create an “exhaustion” of benefits competition between claimants as is clearly the intent of Sec. 65-3.15. The fee schedule is a guideline on how to properly fill out and submit a claim. Such a finding is consistent with the Court of Appeals direction to interpret “no-fault” regulations in such a manner as to not frustrate the legislative intent of requiring prompt payment of benefits. See Nyack Hosp. v. Gen. Motors Accept. Corp., 8 NY3d 294 (NY 2007), citing to Med. Soc. of NY v.Serio, 100 NY2d 854 (NY 2003). Paragraph 11 does not indicate that it regulates benefits for “all” claims on any given day.”
“Accordingly, the Court enters judgment for the plaintiff allowing reimbursement for 8 of its claims’ 10 billing units, in the sum of $1,876.76 plus appropriate statutory interest, attorneys fees and costs.”
This is a District Court opinion so its precedential value is limited. I believe ground rule 11 applies to all services, except chiropractor CMT services rendered on the same day as PT/OT/MT services. To hold otherwise could allow $1000 PT service type per diem billing. This decision is against the weight of authority from most arbitrators and other judges.
I would note that in Ashraf Ashour v. Interboro, the fee schedule issue involved CPT Code 97039 when 8 units of PT were already billed and paid from another provider on the same dates of service. The Appellate Term granted our summary judgment motion. So, take Doctor in the House for what it is worth.
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Legal Update (February 2026): Since this 2013 post discussing the “8 units” limitation under Paragraph 11 of the New York Compensation Medical Fee Schedule, there may have been amendments to the fee schedule provisions, updates to reimbursement unit calculations, or regulatory clarifications regarding multiple procedure billing limitations. Practitioners should verify current fee schedule regulations and any subsequent court interpretations of the unit limitation rules.
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Fee Schedule Issues in No-Fault Insurance
The New York no-fault fee schedule establishes the maximum reimbursement rates for medical treatment provided to injured motorists. Disputes over fee schedule calculations, coding, usual and customary charges, and the applicability of workers compensation fee schedules to no-fault claims are common. These articles analyze fee schedule regulations, court decisions on reimbursement disputes, and the practical challenges providers face in obtaining appropriate payment under the no-fault system.
118 published articles in Fee Schedule
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
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