June 17, 2022

UGP Acupuncture, P.C. v GEICO Ins. Co. (2022 NY Slip Op 50609(U))

Headnote

The court considered a case where UGP Acupuncture, P.C. sought to recover first-party no-fault benefits from GEICO Ins. Co. The main issue decided was whether GEICO Ins. Co. had properly paid claims using specific CPT codes in accordance with the workers' compensation fee schedule for acupuncture services performed by chiropractors. The court ultimately held that the order from the Civil Court, which denied UGP Acupuncture, P.C.'s motion for summary judgment and granted GEICO Ins. Co.'s cross motion seeking summary judgment dismissing the claims billed using those specific CPT codes, was affirmed. The decision was based on the reasoning and decision in a similar case, Mind & Body Acupuncture, P.C., as Assignee of Wilson, Bernadette v State Farm Mut. Auto. Ins. Co. The holding of the case was ultimately in favor of GEICO Ins. Co.'s decision to dismiss the claims billed using the specific CPT codes.

Reported in New York Official Reports at UGP Acupuncture, P.C. v GEICO Ins. Co. (2022 NY Slip Op 50609(U))

UGP Acupuncture, P.C. v GEICO Ins. Co. (2022 NY Slip Op 50609(U)) [*1]

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

2022 NY Slip Op 50609(U) [75 Misc 3d 141(A)]

Decided on June 17, 2022

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This opinion is uncorrected and will not be published in the printed Official Reports.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 June 17, 2022

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

PRESENT: : THOMAS P. ALIOTTA, P.J., MICHELLE WESTON, WAVNY TOUSSAINT, JJ
2021-119 K C

UGP Acupuncture, P.C., as Assignee of Sanhueza, Nancy, Appellant,
against
GEICO Ins. Co., Respondent.

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

Appeal from an order of the Civil Court of the City of New York, Kings County (Odessa Kennedy, J.), dated March 3, 2021. The order, insofar as appealed from, upon reargument, adhered to that court’s prior determination in an order dated March 16, 2020 granting the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims billed using CPT codes 97810 and 97811.

ORDERED that the order, insofar as appealed from, is affirmed, with $25 costs.

In this action by a provider to recover assigned first-party no-fault benefits, plaintiff moved for summary judgment and defendant cross-moved for summary judgment dismissing the complaint. By order dated March 16, 2020, the Civil Court denied plaintiff’s motion for summary judgment and granted the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims billed using CPT codes 97810 and 97811 on the ground that defendant had paid these claims in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors. Plaintiff thereafter moved to renew and reargue its motion for summary judgment and its opposition to defendant’s cross motion. Plaintiff appeals from so much of an order of the Civil Court dated March 3, 2021 as, upon reargument, adhered to the court’s prior determination in the March 16, 2020 order denying plaintiff’s motion for summary judgment and granting the branch of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims billed using CPT codes 97810 and 97811.

For the reasons stated in Mind & Body Acupuncture, P.C., as Assignee of Wilson, Bernadette v State Farm Mut. Auto. Ins. Co. (— Misc 3d —, 2022 NY Slip Op — [appeal No. 2019-1418 K C], decided herewith), the order, insofar as appealed from, is affirmed.

ALIOTTA, P.J., WESTON and TOUSSAINT, JJ., concur.

ENTER:
Paul Kenny
Chief Clerk
Decision Date: June 17, 2022