Gl Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., 2013 NY Slip Op 51748(U)(App. Term 2d Dept, 2013)
“The claims had been denied on the ground that they exceeded the amount permitted by the workers’ compensation fee schedule, and that defendant had fully paid plaintiff for the services billed for in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors. Contrary to plaintiff’s assertion, an affidavit by defendant’s claims representative established that defendant had properly used the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which plaintiff was entitled to receive for the services at issue”
This was my case and the codes in issue were: 97810, 97811 and 99202. The bills were paid in accordance with what a chiropractor would be entitled to had (s)he billed for the services.
