Key Takeaway
The 2015 Gutierrez ruling behind this historical CPT 20553 note: fee proof, Ground Rules 3 and 5, and the denial's attached explanation.
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.
This April 2015 note quotes Gutierrez v State Farm. Its former case name and link pointed to Alleviation, a different decision issued the following month.
Historical note: This older fee dispute predates the service-date regime applied in Oleg’s Acupuncture (2018), which preserved the excessive-fee defense without a timely denial for post-April-2013 services; payment proof still mattered.
Last reviewed: September 2026. Original publication date retained.
Correct case, limited holding
Gutierrez v State Farm, 2015 NY Slip Op 50379(U) affirmed dismissal after the insurer supported its application of Ground Rules 3 and 5 and its use of code 20552 to calculate payment for the services billed under 20553. Its affidavits also explained an overpayment caused by counting one extra injection. The provider did not rebut the showing.
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The checked denial box did not stand alone: the form referred to an attached Explanation of Review. The opinion does not make checking a box a substitute for proving a reduction.
Alleviation v State Farm, 2015 NY Slip Op 50778(U), decided in May, involved a similar calculation but is a different case. The original title and April publication date remain as part of the archive; neither supplies a current code value. For a new dispute, identify the service date, schedule version, treatment count and actual payment explanation.
Historical commentary from the archive
Jason’s original reaction follows. His shorthand about the checked box must be read with the attached explanation and supporting affidavits identified in Gutierrez, not as a box-only rule:
First off, good job to Linda Filosa, Esq from Richard Lau’s office on an impressive affirmance. These fee schedule issues in many ways are sui generis and each raise issues of first impression.
Second, this case explains the methodology of how you get from a BR report code (CPT Code 20553 ) to a scheduled use Code (CPT code 20552) with the application of the 50% reduction of Ground Rule 5.
Third, in the pre 2013 fee schedule precludability era, this case describes how box #18 being checked is (shall we say) the be all and end all of the analysis.
Good win for State Farm!!
Connect to the Encyclopedia
- Fee-schedule defense hub: cases, proof and later developments
- Renelique: payment proof for 20553
- Compas Medical: payment proof versus a suspected code substitution
- Jason’s G0283 note: attended and unattended coding in context
- 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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