118 articles by Jason Tenenbaum, Esq.
These articles cover key topics related to fee schedule under New York law. Each article breaks down recent court rulings, explains legal standards, and offers practical guidance. Attorney Jason Tenenbaum has written on this subject since 2008, drawing on over two decades of practice in personal injury, no-fault insurance defense, and employment law across Long Island and New York City.
If you have questions about a specific case or need legal advice, call our office at 516-750-0595 for a free consultation.
Explore the Forrest Chen v. GEICO case and its impact on acupuncture insurance reimbursements in NY. Key insights for providers and patients.
Acupuncture Reimbursements and Insurance Legalities Explained — Read More →
NY court rules simple addition insufficient to prove proper fee schedule calculations in no-fault insurance case, requiring detailed evidence of code utilization.
Simple addition is insufficient — Read More →
NY court case on healthcare provider's right to recover reasonable value for medical services when insurance claims are improperly processed or denied.
Reasonableness of healthcare bill — Read More →
New York court ruling highlights insurance carriers must properly authenticate documents when denying physical therapy claims under fee schedule limits.
PT Fee schedule denial not substantiated — Read More →
Court ruling demonstrates how certified medical coders can establish proper fee schedule application in New York no-fault insurance disputes through expert affidavits.
The power of the certified medical coder — Read More →
New York court ruling clarifies CPT codes 97813 and 97814 acupuncture billing rates under workers' compensation fee schedule for no-fault insurance claims.
CPT Code 97813 and 97814 — Read More →
Court upholds chiropractor fee schedule rates for acupuncture services in NY no-fault insurance case, limiting reimbursement despite provider credentials.
The chiropractor rate — Read More →
New York court ruling demonstrates how healthcare providers can lose no-fault claims due to verification failures and fee schedule violations in insurance disputes.
120-day rule and Fee Schedule — Read More →
Analysis of Blackman v Nationwide Ins. case addressing verification affidavit mailing presumptions and fee schedule defense preservation requirements in NY no-fault law.
Verification and fee schedule issues — Read More →
Learn NY-NJ cross-border medical billing & fee schedules. Expert analysis of Excel Surgery decision & out-of-state treatment. Call 516-750-0595.
Fee schedule is not precluded/ New Jersey FS discussion — Read More →
Learn how certified medical coders impact workers comp billing disputes in NY. Expert legal analysis of fee schedules & coding. Call 516-750-0595.
Certified Professional Coder — Read More →
Learn how NY No-Fault by report billing works and insurance carrier verification requirements. Expert analysis of Bronx Acupuncture case. Call 516-750-0595.
New York No-Fault By Report Billing: Insurance Carrier Verification Requirements Explained — Read More →
Court rules CPT code book and CPT Assistant are admissible in NY no-fault insurance fee disputes, reversing arbitrator's exclusion of coding guidance materials.
The CPT code book and CPT Assistant are admissible as a matter of course — Read More →
Expert analysis of NY acupuncture billing codes & no-fault insurance disputes. Learn your rights when insurance denies treatment. Call 516-750-0595 for help.
Understanding Acupuncture Billing Codes in New York No-Fault Insurance Claims | Long Island Personal Injury Lawyer — Read More →
New April 2019 Workers Compensation fee schedule changes affecting NY no-fault insurance: chiropractic billing limits, eliminated ROM/MTT/PFT, reduced EMG costs, and PT rate increases.
April 2019 (add 18 months for no-fault): a new fee schedule — Read More →
Insurance companies reduce medical bills through down-coding. Learn your rights when CPT codes are changed and how to challenge improper billing decisions. Call 516-750-0595
Understanding Medical Billing and Down-Coding in New York No-Fault Insurance Claims — Read More →
Analysis of Pavlova v Allstate case on "by report" billing requirements and verification procedures in NY no-fault insurance claims (156 chars)
The By Report paradigm — Read More →
Village Medical Supply case shows insurance carriers can use 11 NYCRR 65-3.2(c) to defend verification requests, marking a shift in no-fault insurance litigation strategy.
A 65-3.2 sighting — Read More →
NY court upholds workers' compensation fee schedule for acupuncture services and rejects fee schedule defense preclusion in 2018 no-fault insurance case.
More Acupuncture fee Schedule – no new ground covered here — Read More →
Appellate Division rules CPM reimbursement must be at general public rental value. Analysis of 6-year no-fault insurance billing dispute and DFS/WCB regulatory gaps.
CPM – now it is up to DFS and WCB to address the problem — Read More →
Court ruling on acupuncture needle reinsertion claims raises questions about partial false billing defenses in NY no-fault insurance cases.
+15 minute decision begs a better question — Read More →
NY Workers' Compensation Board clarifies 8 RVU limitation rules for physical therapy and chiropractic treatment in no-fault insurance claims.
8 units may apply to various specialties — Read More →
Workers Compensation Board clarifies 8-unit daily limit rule for PT treatments in NY no-fault insurance cases - CMT codes don't count toward non-chiro limits.
8 units per diem – the Workers Compensation Board has spoken — Read More →
Analysis of Oleg's Acupuncture v Hereford Insurance case examining fee schedule defenses, untimely denials, and certified medical coder affidavits in NY no-fault claims.
Fee Schedule/not precluded — Read More →
Court ruling establishes that a certified medical coder's affidavit provides sufficient evidence to support workers' compensation fee schedule defenses in summary judgment motions.
Certified medical coder sufficient — Read More →
Civil Court ruling supports CPM reimbursement claims by medical providers, creating significant implications for no-fault insurance reimbursement rates and regulatory oversight.
CPM from the Civil Court — Read More →
Analysis of BR code requirements in New York no-fault insurance fee schedule disputes, examining provider prima facie cases and affirmative defenses.
By report? Again? — Read More →
NY court rules insurance company failed to substantiate fee schedule defense by not proving correct conversion factor was used in calculating reimbursement rates.
Fee schedule defense not substantiated — Read More →
Court ruling on CPT Code 97039 billing disputes in NY no-fault insurance cases, covering "By Report" documentation requirements and insurer denial defenses.
CPT Code 97039 again — Read More →
Court ruling in Laga v GEICO shows insurers must provide precise proof when applying Ground Rule 11 reductions to no-fault medical bills under New York's fee schedule.
Fee schedule defense failed — Read More →
Court approves chiropractor rates for evaluation and consultation codes in no-fault insurance case, upholding workers' compensation fee schedule reductions.
Court approves the chiro rate for Evaluation codes and consultation codes — Read More →
Court rules insurers must request additional documentation for "By Report" CPT codes before denying no-fault claims, addressing proper claim procedures.
By-Report — Read More →
New Jersey implements crucial no-fault insurance fee schedule regulation 68.6 in 2018, addressing long-standing billing inconsistencies and overbilling practices.
A new 68.6 is coming next year — Read More →
Court upholds insurance carrier's repricing of CPT code 64550 to 97014 in no-fault case, demonstrating proper application of workers' compensation fee schedule.
Repriced CPT Code 64550 — Read More →
Court decision analysis on acupuncture billing codes in NY no-fault insurance cases, examining fee schedule defenses and discovery requirements for CPT codes 97810 and 97811.
Acupuncture that is broken down by code — Read More →
Court rejects insurer's "out of scope" defense for CPT code 97039, finding triable issues regarding proper denial of no-fault acupuncture claim.
CPT Code 970309 — Read More →
NY court confirms acupuncturists are limited to chiropractor fee schedule rates regardless of prior payments at higher medical doctor rates in no-fault insurance claims.
No acupuncture fee schedule estoppel — Read More →
Court upholds insurer's application of workers' compensation fee schedule to CPT code 20553, highlighting ongoing disputes over proper billing methodologies in no-fault cases.
C.f. 20553 — Read More →
New York court decision on medical necessity and fee schedule defenses in no-fault insurance cases, featuring expert affidavit requirements and proper coding analysis.
Functional ATIC/ medial necessity and fee schedule defense susbstantiated — Read More →
ATIC's functional litigation defense strategy in Compas Med v American Trust Insurance Co case involving fee schedule defenses and CPT code bundling issues.
Back when ATIC had a functional litigation defense strategy — Read More →
Court ruling on hearsay evidence in no-fault insurance fraud defenses and fee schedule denial requirements. Analysis of Box #18 denials and coverage disputes.
Hearsay insufficient to substantiate a fraud defense/Fee Schedule discussion — Read More →
Analysis of Gentle Acupuncture v Tri-State Consumer Insurance case examining fee schedule defenses and affidavit requirements in New York no-fault claims.
Substantive fee schedule discussion/Procedural analysis — Read More →
Court rules insurance company failed to prove proper denial of non-acupuncture CPT codes 97026 and 97016 under workers' compensation fee schedule requirements.
Non acupuncture based add on codes – issue of fact — Read More →
Court ruling on fee schedule defense preservation in NY no-fault insurance claims, addressing the eight unit rule and arbitrator award reversal.
The Maslow specificity rule went up in a plume of smoke — Read More →
Appellate Term ruling demonstrates how no-fault insurers lose defenses when they fail to timely deny claims, particularly for acupuncture services under New York's fee schedule.
A true prima facie showing on summary judgment motion — Read More →
Court limits on judicial notice in no-fault insurance cases - workers' compensation fee schedule requires proper foundation and notice under CPLR 4511
Judicial Notice has it outter limits — Read More →
Analysis of Bronx Acupuncture v Hereford case clarifying that by-report codes are verification issues, not automatic denials in NY no-fault insurance claims.
The By-Report — Read More →
Easy Care Acupuncture v MVAIC case explores policy exhaustion defenses and fee schedule reductions in New York no-fault insurance acupuncture claims disputes.
Policy exhaustion and fee schedule concerns — Read More →
Court ruling establishes that a claims representative's affidavit explaining fee calculations using relative values and conversion factors creates sufficient prima facie evidence.
Claims representative’s attestation is sufficient to make a prima facie showing — Read More →
Liberty Chiropractic v 21st Century Insurance case examining fee schedule defenses and 8-unit limitations under NY no-fault law, authentication requirements.
Fee Schedule and 8 unit issue — Read More →
New York court rules that DME not included in fee schedules can still be compensable under 11 NYCRR 68.5, overturning insurance carrier arguments.
The DME equivalent of Robert Physical Therapy plays out — Read More →
New York proposes amending 11 NYCRR 68.6 to limit out-of-state no-fault health service reimbursement to highest NYS fee schedule rates for 2016.
Amendment of 11 NYCRR 68.6 coming soon — Read More →
Court ruling shows "interboard" IME cutoff requirements in action - acupuncture provider loses no-fault case for lack of medical evidence opposing summary judgment motion.
A sighting of “interboard” in action — Read More →
Court ruling clarifies that insurance companies can raise fee schedule defenses without specific details in denial forms, contrary to recent AAA arbitration trends.
The denial just has to set forth a fee schedule defense — Read More →
Analysis of Tyorkin v Garrison case discussing New York no-fault insurance regulation fee schedule defenses and NF-10 denial form requirements in 2016 court decision.
Interesting new regulation fee schedule discussion and an example of sloppiness? — Read More →
Court reverses summary judgment denial for CPT code 97026 infrared therapy billing, reinforcing recent case law favoring healthcare providers in no-fault disputes.
CPT Code 97026 — Read More →
Supreme Court ruling applies Medicaid fee schedule to CPM rental in no-fault insurance case, potentially ending reasonable and customary charges for providers.
Supreme Court held that Medicaid fee schedule applies to CPM rental — Read More →
New Jersey fee schedule prevails in NY no-fault cases for out-of-state services. Appellate Term ruling on geographic fee schedules and post-2013 defense changes.
New Jersey fee schedule prevails — Read More →
Court ruling establishes that certified professional coder's affidavit can prove proper fee schedule application, potentially impacting arbitration arguments about coder qualifications.
Coder’s affidavit is sufficient to prove non-conformity with the fee schedule — Read More →
Court upholds $4,000 to $645.90 fee schedule reduction for CPT code 20553, explaining Ground Rule methodology and potential carrier recoupment analysis.
Another old fee schedule 20553 reduction case — Read More →
Landmark case establishing first application of 11 NYCRR 65-3.8(g)(1)(ii) regarding prevailing fees and timeliness requirements in New York no-fault insurance claims.
First application of 11 NYCRR 65-3.8(g)(1)(ii) — Read More →
NY court reduces CPT Code 20553 billing from $4,000 to under $1,000 using workers' compensation fee schedule Ground Rules 3 and 5 in no-fault insurance case.
CPT Code 20553 reduced from $4,000 to less than $1,000 — Read More →
NY court ruling on acupuncture billing codes 97039 and 97026 in no-fault insurance claims, establishing fee schedule guidelines for licensed acupuncturists.
Acupuncture may be billed using 97039 and 97026 — Read More →
Court ruling on facility fees for office-based surgery under NY no-fault insurance law, examining Insurance Law § 5108 and Workers' Compensation fee schedules.
It came and I am surprised – but if everything is now done in New Jersey, what’s the long term impact? — Read More →
Court ruling establishes that fee schedule vendors can properly substitute claims representatives in affidavits defending workers' compensation fee schedule determinations.
Fee schedule vendor properly substituted for a claims rep. affidavit — Read More →
New York court upholds GEICO's fee schedule reductions for acupuncture services, rejecting provider's challenge in workers' compensation case.
Another acupuncture fee schedule challenge fails — Read More →
New Jersey fee schedule properly applied to out-of-state services under NY no-fault law. Court ruling prevents coding battles, establishes clear reimbursement rules.
New Jersey fee schedule is proper as a matter of law — Read More →
Court ruling shows evolution in acupuncture fee schedule defense standards, moving from procedural comparison requirements to simpler denial efficacy tests.
Acupuncture fee schedule defense again — Read More →
Long Island no-fault attorney discusses G0283 billing code replacing 97032 electrical stimulation and the need for prima facie burden of proof in fee schedule defenses.
My encounter with G0283 — Read More →
New Jersey fee schedule requirements for NY no-fault claims when providers perform services outside New York State under 11 NYCRR § 68.6 prevailing fee regulations.
Fee schedule in New Jersey — Read More →
NY appellate court sustains acupuncture provider's right to physician rates over chiropractor schedule in no-fault insurance fee dispute case analysis.
Acupuncture paid at physician rate sustained on appeal — Read More →
New York acupuncture fee schedule case analysis - chiropractor rate reductions, evaluation codes, and physical therapy billing issues in no-fault insurance claims.
Acupuncture fee schedule — Read More →
Analysis of Triumph Assoc. Physical Therapy v New York Central Mutual case addressing Ground Rule 11 fee schedule disputes and IME-based medical necessity denials in no-fault law.
Ground rule 11 and the IME cut off — Read More →
SK Prime Med. Supply case marks first application of Great Wall precedent beyond acupuncture, establishing fee schedule standards for durable medical equipment in no-fault insurance.
Mr. SK Prime expanded Great Wall — Read More →
Kings County judge reversed again for rejecting Great Wall acupuncture fee schedule ruling. Appellate Term upholds chiropractor rate limitations for acupuncture services.
Another Civil Kings Judge gets reversed for deciding that Great Wall does not apply — Read More →
Court rules fee schedule defense succeeds with employee affidavit but medical necessity defense fails when plaintiff submits sworn letter from treating chiropractor
Comp defense succeeds but medical necessity defense falters — Read More →
New York courts require competent expert medical proof to challenge medical necessity in no-fault insurance disputes, with fair and reasonable charges being key factors.
Medical necessity disputes in major medical disputes may be raised at any time — Read More →
First Department ruling on acupuncture fee schedule disputes in no-fault cases, highlighting importance of proper billing rates and timely denial procedures.
More acupuncture from the First Department — Read More →
First Department ruling on acupuncture fee schedules in no-fault insurance cases, analyzing chiropractor rate limitations and prima facie defense requirements.
Acupuncture fee schedule from the First Department — Read More →
Suffolk County District Court rules on 8-unit billing limit for medical providers under NY no-fault insurance fee schedule, allowing reimbursement despite multiple claims.
8 units applies to billing medical providers only? — Read More →
Court ruling highlights insurance companies must address initial evaluation codes separately from routine treatment codes in no-fault insurance disputes.
Initial visit compensable — Read More →
New York court rules that chiropractor fee schedules apply to acupuncture services regardless of provider type, impacting no-fault insurance reimbursement rates.
Chiropractor fee schedule applies to all billed for codes — Read More →
Court rules acupuncturists can bill for initial visits under code 99202, but leaves open question about reimbursement rates compared to chiropractors.
Initial visit allowed – open question being how much — Read More →
New York court rejects constitutional challenge to acupuncture fee schedule in no-fault insurance case, highlighting ongoing disputes over reimbursement rates.
The constitutional challenge — Read More →
Insurance companies must properly submit fee schedules as evidence when denying acupuncture claims, or risk having their payment denials overturned by courts.
It looks like someone did not include the fee schedule as an exhibit in their acupuncture motion — Read More →
New York court ruling demonstrates how insurance companies can successfully defend no-fault claims when healthcare providers fail to respond to verification requests.
Another verification again — Read More →
Court decision on CPT codes 99455 and 99456 billing abuse in New York no-fault insurance MUA claims, featuring Flatbush Chiropractic v MetLife arbitration award.
An interesting decision on a well known performer of enhanced MUA — Read More →
New York appellate court reverses lower court decision in Oriental World Acupuncture v GEICO, highlighting the importance of strategic appellate arguments in no-fault cases.
Surprised? — Read More →
New York court rules that denial letters with EOB forms adequately preserve fee schedule defenses in no-fault insurance disputes, even without explicit notice requirements.
Denial and EOB is sufficient to preserve fee schedule defense — Read More →
New York court ruling on fee schedule defense failures in no-fault insurance summary judgment motions, highlighting judicial notice requirements for claims examiners.
The failure to affirmatively seek judicial notice of the fee schedule (again) proves fatal to a motion for summary judgment — Read More →
Court case analysis examining chiropractor MUA billing disputes under NY no-fault fee schedules, including rate limitations and multiple procedure rules.
More MUA – this one is over the top — Read More →
Court grants renewal motion after law office failure, defendant wins summary judgment in no-fault insurance case when plaintiff fails to raise triable issues of fact.
Renewal granted and Plaintiff loses. — Read More →
New York Appellate Term denies insurer's motion to dismiss acupuncture provider's claim for initial session, reinforcing provider rights under no-fault law.
Another motion to dismiss an initial acupuncture session is denied — Read More →
New York appellate court reinforces requirement for insurance carriers to properly submit fee schedules as evidence in acupuncture reimbursement disputes under no-fault law.
Acupuncture fee schedule (again) — Read More →
Learn about Article 28 licensing requirements for surgical centers in NY. Expert analysis of Upper E. Side Surgical v State Farm case and reimbursement rules.
Surgical Center does not need to comply with Article 28 to be reimbursed under no fault — Read More →
NY court rules workers' compensation fee schedule incorporated by reference in no-fault acupuncture cases, establishing precedent for billing code requirements.
Acupuncture – the fee schedule is incorporated by reference — Read More →
Top 10 arguments about acupuncture fee schedules in NY no-fault insurance law, including court precedent and billing disputes between providers and insurers.
Nothing gives me a bigger headache than reading about acupuncture and the fee schedule — Read More →
Court ruling demonstrates that insurance companies must timely deny claims to preserve fee schedule defenses in New York no-fault litigation.
Fee schedule defense not preserved abesent a timely denial — Read More →
W.H.O. Acupuncture v Geico case analysis covering acupuncture fee schedule constitutionality, appealable orders, and judgment preparation requirements in NY no-fault law.
WHO? — Read More →
Judge Ciaffa rules on medical provider billing practices, comparing charges to uninsured patients vs. insurance reimbursement rates in Nassau Anesthesia v Chin case.
How much was that anesthesia really worth? — Read More →
Expert analysis of SAPA regulations and administrative interpretation in NY no-fault insurance. Long Island & NYC personal injury attorneys. Call 516-750-0595.
Understanding SAPA Regulations: When Administrative Interpretation Falls Short — Read More →
Understand how Civil Court JHOs can challenge higher court precedent through administrative deference in NY no-fault insurance law. Expert legal analysis.
Only in no-fault can a Civil Court JHO "reverse" the holdings of the Appellate Divisions and the Court of Appeals — Read More →
Learn how chiropractor fee schedules affect acupuncture reimbursement under NY no-fault insurance. Expert legal analysis from Long Island personal injury attorneys.
Chiropractor? fee schedule applied to acupuncture — Read More →
New York appellate court clarifies acupuncture billing rates, medical necessity proof standards, and scope of practice in no-fault insurance disputes.
Prior rulings on acupuncture fee schedule and proof needed to oppose a medical necessity motion stand — Read More →
NY acupuncture reimbursement case: Appellate Term rules on proper billing codes 97810, 97811 and initial consultation fees under no-fault insurance law.
Acupuncture is reimbursable at the….(fill in the blank)(again) — Read More →
Civil Court ruling confirms chiropractors can bill for manipulation under anesthesia (MUA) services in no-fault insurance claims with specific rate limitations.
A chiropactor may bill for manipulation under anethesia services – but you knew that already — Read More →
Appellate Term Second Department reaffirms acupuncture services reimbursable at chiropractor rates under NY no-fault insurance law, rejecting invalid defenses.
Give it up already? — Read More →
Appellate Term ruling creates triable issue of fact regarding separate reimbursement for range of motion testing versus inclusion in office visit services.
Another case where the Appellate Term seems to hold that a triable issue of fact is raised regarding the compensability of range of motion testing — Read More →
Expert legal analysis of fee schedule defense requirements in no-fault insurance cases. Call (516) 750-0595 for experienced representation in Long Island and NYC.
Fee Schedule Defense Requirements in No-Fault Insurance Cases | Long Island & NYC Legal Analysis — Read More →
Expert legal guidance on ROM and MM testing billing disputes for Long Island and NYC healthcare providers. Navigate inconsistent court decisions and maximize reimbursements. Call 516-750-0595.
Inconsistent Opinions Regarding Range of Motion Fee-Schedule Denials: A Guide for Long Island and NYC Healthcare Providers — Read More →
Learn why expert affidavits are crucial for defending medical billing unbundling claims in NY no-fault insurance. Essential insights for Long Island & NYC legal professionals. Call 516-750-0595.
Defense of unbundling requires coding expert affidavit — Read More →
Analysis of St. Vincent Med Care v Country-Wide Insurance case regarding fee schedule defenses and bundled services in NY no-fault insurance claims for healthcare providers.
Fee Schedule Defenses in NY No-Fault Insurance: St. Vincent Med Care Case Analysis — Read More →
Learn how NY courts established prima facie defense for acupuncture fee disputes, limiting coverage to chiropractor rates. Expert analysis for Long Island & NYC patients.
NY Acupuncture Prima Facie Defense: Chiropractor Rate Limitations Upheld — Read More →
Learn how NY courts limit acupuncture practitioners to chiropractor fee schedules in no-fault cases. Expert analysis for Long Island & NYC alternative medicine coverage.
NY Acupuncture Fee Schedules: Licensed Practitioners Limited to Chiropractor Rates — Read More →
Understanding acupuncture fee schedule requirements in New York no-fault cases. Legal guide on chiropractic rate reimbursement for acupuncture providers.
The chiropractor rate is all that an acupuncurist is entitled to — Read More →
Learn about acupuncture reimbursement rates in New York no-fault insurance cases. Important legal precedent affecting NYC and Long Island patients. Call 516-750-0595.
Acupuncture Reimbursement Rates in New York No-Fault Insurance Cases — Read More →
NY insurance carriers must provide competent evidence for fee schedule denials. Long Island personal injury lawyer explains OS Tigris case. Call 516-750-0595.
Fee schedule defense – competent evidence? — Read More →
Expert legal analysis on fee schedule defense in New York. Long Island personal injury attorney explains DOI deference and your no-fault rights. Call 516-750-0595.
Fee schedule defense – Appellate Division gives due deference to the DOI — Read More →Injured? Don't Wait.
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