Key Takeaway
SK Prime Med. Supply case marks first application of Great Wall precedent beyond acupuncture, establishing fee schedule standards for durable medical equipment in no-fault insurance.
Expanding Precedent: Great Wall Principles Applied to Medical Equipment
The 2014 decision in SK Prime Med. Supply, Inc. v State Farm represents a significant development in New York No-Fault Insurance Law, marking the first time courts applied the influential Great Wall precedent beyond acupuncture services to durable medical equipment fee schedules. This case demonstrates how established legal principles can expand to address similar disputes across different medical service categories.
The Great Wall precedent, originally established in acupuncture billing disputes, created important standards for how insurance companies can challenge provider billing amounts using appropriate fee schedules. When dealing with fee schedule disputes, courts look for clear documentation and proper regulatory authority to determine correct reimbursement amounts.
Jason Tenenbaum’s Analysis:
SK Prime Med. Supply, Inc. v State Farm Mut. Auto. Ins. Co., 2014 NY Slip Op 50630(U)(App. Term 2d Dept. 2014)
This is the first application of “Great Wall” outside the realm of the acupuncture fee schedule. It is great to see meritless appeals create good case law.
” Finally defendant’s submission of its claims representative’s affidavit, along with a copy of the “NYS Medicaid DME Services Fee Schedule,” which has been adopted as the Durable Medical Goods Fee Schedule for Workers’ Compensation (see 12 NYCRR 442.2 ), was sufficient to demonstrate that plaintiff was entitled to receive $22.04 for Code E0190, the sum defendant has already paid, and not $24.00, the sum that plaintiff had billed (see Great Wall Acupuncture, P.C. v GEICO Ins. Co., 26 Misc 3d 23 ).”
Key Takeaway
This decision establishes that the Great Wall precedent’s methodology for fee schedule disputes extends beyond acupuncture to durable medical equipment. Insurance companies can successfully defend against overbilling by providing proper documentation of applicable fee schedules, even when those schedules are adopted from other regulatory frameworks like Workers’ Compensation or Medicaid.
Legal Update (February 2026): Since this 2014 post, New York’s no-fault fee schedules and reimbursement methodologies have undergone multiple regulatory updates and amendments. The referenced Medicaid DME Services Fee Schedule and related no-fault reimbursement provisions have been subject to periodic revisions that may affect how the Great Wall precedent applies to current durable medical equipment disputes. Practitioners should verify current fee schedule provisions and regulatory frameworks when applying these precedential principles to contemporary cases.
