The CPT code book and CPT Assistant are admissible as a matter of course

Key Takeaways

• McMahon was decided May 9, 2019, by the Appellate Division, First Department.
• The disputed issue was refusal to consider CPT Assistant in a no-fault coding dispute.
• The court traced incorporation from the medical fee schedule through the CPT book to CPT Assistant.
• It vacated the award and ordered a new arbitration, not a final reimbursement award for the insurer.
• Later Suffolk County litigation illustrates why considering guidance is different from letting it override express fee-schedule rules.

What did Global Liberty v McMahon decide?

In Matter of Global Liberty Ins. Co. v McMahon, 172 AD3d 500 (1st Dept 2019), the First Department rejected the categorical exclusion of CPT Assistant from the coding dispute before it.

The official reporter identifies Jason Tenenbaum as counsel for Global Liberty. His original May 12, 2019 post discussed why a dispute over the materials an arbitrator would consider warranted an appeal.

The historical title uses broad language. The actual disposition is more precise: relevant portions of CPT Assistant had to receive consideration in a new arbitration conducted consistently with the decision.

The coding dispute and the review path

The provider sought no-fault payment for arthroscopic surgery. Global Liberty paid part of the claim, relying on CPT Assistant to support its reimbursement position. The unpaid balance went to arbitration.

The lower arbitrator refused to consider CPT Assistant, treating it as unauthorized under the applicable no-fault law. The master arbitrator affirmed. Supreme Court then denied the insurer’s petition and confirmed the award.

The First Department reversed that order. It granted the petition, vacated the award and remanded to the lower arbitrator. The opinion does not report the outcome of the new proceeding.

The issue was therefore not whether an insurer’s preferred code wins automatically. It was whether an arbitrator could exclude the relevant incorporated guidance before evaluating the reimbursement dispute.

The incorporation chain that mattered

The court identified three connected sources:

1. The Official New York Workers’ Compensation Medical Fee Schedule applicable to the claim.
2. The CPT book, which the schedule directed users to consult for coding rules not listed in the schedule.
3. CPT Assistant, to which the CPT book expressly referred.

The opinion also cited Insurance Law § 5108 and 11 NYCRR 68.0 and 68.1 for application of the Workers’ Compensation fee schedules to no-fault claims.

That chain supplied the basis for considering CPT Assistant. The decision did not reproduce a complete coding manual or make every outside coding opinion controlling.

A present claim still requires identification of the applicable schedule, service dates and relevant materials. This historical note does not supply licensed CPT text or certify a current billing code.

Jason’s original reaction — May 12, 2019

These selections preserve the original account of the appeal:

I was only zapped by this issue once, but once is enough.

Despite the clear wording of the regulation and the Fee Schedule, I knew I was going to be at the First Department on this case.

To me, the rule that I cannot reference the CPT Code book or the CPT Assistant was meritless.

The value of that account is specific: Jason challenged the exclusion of the material needed to argue the coding issue. His frustration with arbitration review is commentary, distinct from the court’s reasoning.

His later October 2019 arbitration-review roundup returned to McMahon while discussing other Article 75 decisions. It records his evolving view of review standards, rather than a second version of this case history.

Later context: Atlantic Medical in Suffolk County

Atlantic Medical & Diagnostic v State Farm, 84 Misc 3d 1258(A), was decided December 12, 2024, in Suffolk County District Court, Third District.

That trial-level dispute concerned multiple units of ultrasound guidance used with trigger-point injections. The insurer relied on outside coding guidance; the provider relied on express provisions of the fee schedule.

The court discussed McMahon but held that extrinsic authority did not supersede the schedule’s own rules. On its record, it awarded judgment to the providers.

This is a later application at a different court level, not an appellate overruling of McMahon. The distinction is useful: authority that must be considered is not necessarily authority that controls the result.

How this appeal fits the firm’s archive

The earlier Professional Chiropractic Care appeal challenged a master award’s treatment of an IME defense. The Medco Tech appeal involved causation evidence and a new hearing.

Together, the notes show different reasons for pursuing review. They do not establish a general right to retry factual disputes in court whenever an arbitration result is disappointing.

For a current no-fault defense review, assemble the bill, service dates, operative schedule, coding materials, denial and both awards. Distinguish the exclusion issue from the merits of the proposed reimbursement calculation.

The Legal Encyclopedia provides broader topic navigation. This case note retains the narrower question: why CPT Assistant could not be categorically ignored in McMahon.

For review of a current file, request a Free Case Review.

Last reviewed: September 2026 — editorial source check against the 2019 appellate and 2024 trial-level opinions. Original publication date retained; no current coding determination is offered.