Key Takeaway
Court upholds chiropractor fee schedule rates for acupuncture services in NY no-fault insurance case, limiting reimbursement despite provider credentials.
S.O.V. Acupuncture, P.C. v Global Liberty Ins. Co. of N.Y., 2020 NY Slip Op 51004(U)(App. Term 2d Dept. 2020)
Well in a few weeks and to the extent people still treat for motor vehicle accidents, this will be placed in the New York no-fault relic garbage can.
“With respect to the branch of defendant’s motion seeking summary judgment dismissing so much of the complaint as sought to recover the unpaid portion of plaintiff’s claims which were denied on the ground that the amount sought exceeded the amount permitted by the workers’ compensation fee schedule, defendant established that it had fully paid plaintiff for the services billed under CPT codes 97810, 97811, 99202, and 99212 in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 ). Likewise, defendant demonstrated that it had fully paid plaintiff for the services billed under CPT codes 97026, except for the services rendered on December 11, 2015, March 1, 2016, March 17, 2016 and March 28, 2016, in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see id.). Thus, defendant established its prima facie entitlement to summary judgment upon the unpaid portion of those claims.”
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