Key Takeaway
Civil Court ruling supports CPM reimbursement claims by medical providers, creating significant implications for no-fault insurance reimbursement rates and regulatory oversight.
Civil Court Ruling on CPM Reimbursement Creates New Precedent
Continuous Passive Motion (CPM) equipment represents a critical component of post-surgical rehabilitation, particularly following orthopedic procedures. In New York’s no-fault insurance system, disputes over reimbursement for medical equipment and supplies frequently arise between healthcare providers and insurance carriers. The pricing and reimbursement structure for such equipment has become increasingly complex, especially as fee schedule regulations continue to evolve.
A recent Civil Court decision has added another layer to this ongoing dispute, aligning with arbitration trends that favor medical providers seeking appropriate compensation for CPM equipment. This development occurs against a backdrop where surgical reimbursement rates have faced downward pressure through regulatory changes, making equipment reimbursement disputes even more significant for healthcare providers’ financial viability.
Jason Tenenbaum’s Analysis:
Advanced Recovery Equip. & Supplies, LLC v Maya Assur. Co., 2018 NY Slip Op 50022(U)(App. Term 2d Dept. 2018)
The CPM story has been a terrific coup for the medical providers. The American Arbitration Association has consistently ruled in favor of the medical providers. The Courts have generally confirmed arbitration awards. A Civil Court has now taken the AAA position. All that is now left is to see what the Appellate Courts will do.
This is one area where I think both DFS and WCB have dropped the ball. Reimbursement rates have once again declined for surgeries and associated providers through regulation. Yet, this piece of the surgery puzzle now has a larger price tag attached to it than the facility fee and the surgery fee.
Eventually, the regulators will do something…
Key Takeaway
The convergence of arbitration decisions and Civil Court rulings in favor of medical providers regarding CPM equipment reimbursement creates a compelling trend. While surgical and facility fees face regulatory reductions, CPM equipment costs have emerged as a significant expense component, potentially exceeding traditional surgery-related fees and highlighting regulatory gaps in New York no-fault insurance law.
Legal Update (February 2026): Since this 2018 post, New York’s no-fault fee schedule regulations have undergone multiple amendments, potentially affecting CPM equipment reimbursement rates and billing procedures. The regulatory landscape for medical equipment and supplies has evolved significantly, and practitioners should verify current provisions of the fee schedule and any recent court decisions or arbitration trends that may have modified the precedential value discussed.
