Why Trust This Analysis
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.
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)
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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.
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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.
If you need legal help with a fee schedule matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
