November 16, 2018

Acupuncture Now, P.C. v GEICO Ins. Co. (2018 NY Slip Op 51647(U))

Headnote

The court considered the issue of whether a provider could recover first-party no-fault benefits for services billed under specific CPT codes. The defendant appealed the denial of its cross motion seeking summary judgment to dismiss the plaintiff's claims for services billed under CPT codes 97810 and 97811, arguing that the amounts sought to be recovered were in excess of the workers' compensation fee schedule. The court ultimately reversed the order and granted the defendant's cross motion, holding that the plaintiff was not entitled to recover upon claims for services billed under the specified CPT codes. The decision referenced a similar case, Acupuncture Now, P.C., as Assignee of Carlos, Illingworth v GEICO Ins. Co., and based its holding on the reasons stated in that case.

Reported in New York Official Reports at Acupuncture Now, P.C. v GEICO Ins. Co. (2018 NY Slip Op 51647(U))

Acupuncture Now, P.C. v GEICO Ins. Co. (2018 NY Slip Op 51647(U)) [*1]

Acupuncture Now, P.C. v GEICO Ins. Co.

2018 NY Slip Op 51647(U) [61 Misc 3d 143(A)]

Decided on November 16, 2018

Appellate Term, Second Department

Published by New York State Law Reporting Bureau pursuant to Judiciary Law § 431.

This opinion is uncorrected and will not be published in the printed Official Reports.

Decided on November 16, 2018

SUPREME COURT, APPELLATE TERM, SECOND DEPARTMENT, 2d, 11th and 13th JUDICIAL DISTRICTS

PRESENT: : MICHAEL L. PESCE, P.J., THOMAS P. ALIOTTA, DAVID ELLIOT, JJ
2016-1459 K C

Acupuncture Now, P.C., as Assignee of Merkison, Douglas, Respondent,
against
GEICO Ins. Co., Appellant.

Law Office of Goldstein & Flecker (Lawrence J. Chanice of counsel), for appellant. The Rybak Firm, PLLC (Damin J. Toell of counsel), for respondent.

Appeal from an order of the Civil Court of the City of New York, Kings County (Robin Kelly Sheares, J.), entered April 14, 2016. The order, insofar as appealed from and as limited by the brief, denied the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810 and 97811.

ORDERED that the order, insofar as appealed from, is reversed, with $30 costs, and the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810 and 97811 are granted.

In this action by a provider to recover assigned first-party no-fault benefits, defendant appeals, as limited by its brief, from so much an order of the Civil Court as denied the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810 and 97811 on the ground that the amounts plaintiff sought to recover, for services rendered prior to April 1, 2013, were in excess of the workers’ compensation fee schedule.

For the reasons stated in Acupuncture Now, P.C., as Assignee of Carlos, Illingworth v GEICO Ins. Co. (__ Misc 3d ___, 2018 NY Slip Op _____ [appeal No. 2016-1377 K C], decided herewith), the order, insofar as appealed from, is reversed, and the branches of defendant’s cross [*2]motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810 and 97811 are granted.

PESCE, P.J., ALIOTTA and ELLIOT, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: November 16, 2018