2 & 9 Acupuncture, P.C. v. 21st Century Advantage Ins. Co.
This text of 2 & 9 Acupuncture, P.C. v. 21st Century Advantage Ins. Co. (2 & 9 Acupuncture, P.C. v. 21st Century Advantage Ins. Co.) is published on Counsel Stack Legal Research, covering Appellate Terms of the Supreme Court of New York primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.
Opinion
against
21st Century Advantage Insurance Company, Respondent.
Gabriel & Shapiro, LLC (Steven F. Palumbo, Esq.), for appellant. Law Office of Bryan M. Rothenberg (Kenneth F. Popper, Esq.), for respondent.
Appeal from an amended order of the District Court of Suffolk County, Third District (C. Stephen Hackeling, J.), dated January 20, 2016. The amended order, insofar as appealed from as limited by the brief, granted the branches of defendant's motion seeking summary judgment dismissing so much of the complaint as sought to recover for services billed under CPT codes 97026 and 97016.
ORDERED that, on the court's own motion, the notice of appeal from an order dated December 23, 2015 is deemed a premature notice of appeal from the amended order dated January 20, 2016 (see CPLR 5520 [c]); and it is further,
ORDERED that the amended order, insofar as appealed from, is reversed, without costs, and the branches of defendant's motion seeking summary judgment dismissing so much of the complaint as sought to recover for services billed under CPT codes 97026 and 97016 are denied.
In this action by a provider to recover assigned first-party no-fault benefits, defendant moved for summary judgment dismissing the complaint, arguing that it had paid plaintiff for the services at issue in accordance with the workers' compensation fee schedule. In an amended order dated January 20, 2016, the District Court granted defendant's motion in its entirety. On appeal, plaintiff argues that the District Court should have denied the branches of defendant's motion seeking summary judgment dismissing so much of the complaint as sought to recover for services billed under CPT codes 97026 and 97016.
Upon a review of the record, we find that defendant failed to demonstrate, prima facie, that it had properly denied payment for the unpaid portions of the bills for services billed under [*2]CPT codes 97026 and 97016 in accordance with the workers' compensation fee schedule (see Sama Physical Therapy, P.C. v American Tr. Ins. Co., 53 Misc 3d 129[A], 2016 NY Slip Op 51359[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2016]; W.H.O. Acupuncture, P.C. v Progressive Preferred Ins. Co., 36 Misc 3d 133[A], 2012 NY Slip Op 51335[U] [App Term, 2d Dept, 2d, 11th & 13th Jud Dists 2012]).
Accordingly, the amended order, insofar as appealed from, is reversed and the branches of defendant's motion seeking summary judgment dismissing so much of the complaint as sought to recover for services billed under CPT codes 97026 and 97016 are denied.
Marano, P.J., Garguilo and Brands, JJ., concur.
Decision Date: April 27, 2017
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2 & 9 Acupuncture, P.C. v. 21st Century Advantage Ins. Co., Counsel Stack Legal Research, https://law.counselstack.com/opinion/2-9-acupuncture-pc-v-21st-century-advantage-ins-co-nyappterm-2017.