Key Takeaway
Jason's 2014 G0283 commentary, with the attended-versus-unattended coding distinction and later no-fault by-report verification context.
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.
Jason wrote this reaction to G0283 in 2014. It records his argument for changing no-fault claim proof, not a court ruling or a current code-conversion rule.
Historical note: Jason was proposing a change to claim proof, not reporting one; Bronx Acupuncture (2019) later held that a by-report requirement did not excuse the insurer’s failure to request verification.
Last reviewed: September 2026. Original publication date retained.
Correcting the coding premise
CMS’s 2003 memorandum distinguished unattended stimulation reported to Medicare under G0283 from manual stimulation under 97032. It directed Medicare use of G0283 in place of 97014 for the specified unattended services, not as a general replacement for 97032.
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That federal billing guidance does not determine New York no-fault reimbursement or prove a way around a unit limit. The treatment record, attendance and applicable payer rules need examination.
Jason proposed a different prima facie burden. Later, Bronx Acupuncture (2019) held that the report requirement for an unlisted modality did not excuse the insurer’s failure to request missing information. Neither source establishes the code-conversion practices or out-of-state litigation predictions in the original comment as generally applicable law.
Historical commentary from the archive
Jason’s 2014 commentary is preserved as a period argument, not billing advice. Its code substitutions and New Jersey/Florida comparisons are observations, not holdings independently verified here. In particular, the suggestion that G0283 replaced 97032 should not be followed:
Today was my first encounter with this G0283. I was thinking R2D2 at first and a rerun of Star Wars. I am embarrassed that I have not seen this code before. Perhaps I saw it subconsciously and chose to ignore it hoping it would go away. Well, denial is never the answer.
I have seen 20553 (since losing its BR status) turn into 64999 and we have all seen many 97013 codes turn into 97799 codes. Surface EMG’s became 95999 (occasionally). The list goes on. But G0283 came out of nowhere to replace 97032 (electrical stimulation) and to conceptually beat the 8 unit rule absent a coding review. Very sneaky.
This creative billing is making me seriously think that the courts and arbitrators should read 65-3.8(g)(ii) to force an Applicant to prove merits of its billing as a prima facie burden. I took the reluctant view that this regulation was limited to overturn Encare and Westchester v. American Transit involving the precludability of a fee schedule defense. But in light of a lot of the creative fee coding that I see going on, it just might make sense to make a provider present prima facie evidence explaining why G0283 (or any by report code) should not be evaluated at 97032, or why the “needling” of 97799 should not be a 20553 code. The by-report code technically puts the burden on the provider to demonstrate its veracity; however, the courts have swept this feature of the the fee schedule under the rug under the “proof and amount of claim” formulation that has been the law since 2003.
Proving a negative is the story of New York no-fault. But perhaps it is time to modernize the law as it relates to the fee schedule issue. “Proof and amount of claim” should really require proof that the provider prove the billing is accurate. If you walk into a forthright arbitration in NJ or a County Court in Florida on a no-fault claim and argue otherwise, your case will end quite quickly.
Why is the Empire State so different?
Connect to the Encyclopedia
- Fee-schedule defense hub: cases, proof and later developments
- Compas Medical: payment proof versus a suspected code substitution
- Gutierrez: Ground Rules 3 and 5 in the 20553 dispute
- Renelique: payment proof for 20553
- Bronx Acupuncture: by-report verification and the motion result
For review of a particular no-fault billing dispute, contact our office.
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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