Key Takeaway
New Age v 21st Century: why the insurer failed to win summary judgment on CPT 97026, without establishing the provider's right to payment.
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.
The insurer failed to establish its right to dismissal on the CPT 97026 claim. That is the limited result in New Age Acupuncture v 21st Century, 2016 NY Slip Op 50737(U), decided May 5, 2016. It is not a judgment directing payment of every infrared-treatment bill.
Historical note: New Age (2016) denied the insurer’s motion on one code; later reimbursement must also be checked against the DFS schedule and effective-date guidance.
Last reviewed: September 2026.
What the reversal did
The Appellate Term, Second Department, reversed the grant of the insurer’s summary-judgment motion to the extent it concerned CPT 97026. The insurer had not established its entitlement to judgment as a matter of law on that branch. The brief opinion does not reproduce the denial or specify the precise factual defect.
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Jason’s suspected scope-of-practice explanation below must therefore remain an inference, not a fact supplied by the court.
Why the cited comparisons matter
In Rogy Medical v Mercury (2009), timely denials did not compensate for insufficient proof that the bills exceeded the schedule. In Sunrise Acupuncture v Tri-State (2014), conclusory statements about services outside the provider’s specialty failed to eliminate factual issues.
Those cases show why supporting evidence matters. They do not identify the defect in New Age. A failed insurer motion is not the same as a finding of medical necessity, correct coding or the provider’s entitlement to summary judgment.
For a newer claim, identify the service date, applicable schedule and exact denial ground before relying on this historical result.
Jason’s original note
Jason expressly suspected the basis for the denial; the opinion does not identify it. The original wording, including its typo, follows:
This would be the infrared code. I suspect the insurance carrier denied the billing as “our of scope”. The recent case law would suggest otherwise and this is just a further elucidation of the recent case law.
Connect to the Encyclopedia
Start with the fee-schedule defense hub. Related case notes:
- Urban Well: coding corrections and separate necessity proof.
- OS Tigris: an unsupported fee-schedule defense.
- Live In Grace: the electrical-stimulation codes 97813 and 97814.
- Healing Art: agreed coder testimony on codes 97810 and 97811.
- Quality Comprehensive: fee proof supported only partial dismissal.
- Acuhealth: the missing by-report verification request.
For review of a particular no-fault billing dispute, contact the Law Office of Jason Tenenbaum. Bring the bill, service dates, denial and payment calculation.
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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