Key Takeaway
Analysis of BR code requirements in New York no-fault insurance fee schedule disputes, examining provider prima facie cases and affirmative defenses.
Bronx Acupuncture Therapy, P.C., as asignee of Mejia v Hereford Ins. Co., 2017 NY Slip Op 79291(U)(2d Dept. 2017)
This came out on July, 2017. The Court granted Hereford leave to argue that the failure to satisfy the “BR code” requirements of the fee schedule is fatal to a medical provider’s prima facie case. I am unsure if I agree since the Courts in New York consider all fee schedule issues “defenses”. My next thought is to state that the disclaimer based upon “BR” is sufficient to ultimately force a plaintiff to prove compliance with the rule. The theory for this comes from the “standing” jurisdiction in mortgage foreclosure cases. Pleading this as an affirmative defense – or in NF parlance through a disclaimer – requires an additional element of proof as part of the PF case – in this case compliance with the BR rule. But do I think my above theory is meritorious? Probably not.
If the Courts absent regulatory fiat will authorize billings short of provider fraud where a timely disclaimer is not issued, why should this be different.
Don’t get me wrong – I appreciate Hereford’s position. But after Amaze v. Eagle and Mary Immaculate Allstate (15 and 14 years ago, respectively), these are battles that bare no fruit.
Related Articles
- Fee schedule defense requirements and competent evidence standards
- Understanding competent evidence in fee schedule defense cases
- NY acupuncture prima facie defense and rate limitations
- First application of regulatory fee schedule requirements
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2018 post, New York’s no-fault fee schedules and billing code requirements may have been subject to regulatory amendments or clarifications through Department of Financial Services updates. Additionally, subsequent court decisions may have further refined the application of “BR code” compliance requirements and the treatment of fee schedule defenses in no-fault litigation. Practitioners should verify current fee schedule provisions and recent case law developments when addressing billing code compliance issues.
