12 Fla. L. Weekly Supp. 668b
Insurance — Personal injury protection — Medical bills — Reduction — Needle electromyography procedure — Statutory limitation of charges to 200% of allowable amount under Medicare Part B reimbursement schedule applies only to medically necessary nerve conduction testing when done in conjunction with needle electromyography not to medically necessary electromyography testing procedure alone
SHERMAN BUTLER, Plaintiff, vs. PROGRESSIVE AUTO PRO INSURANCE COMPANY, Defendant. County Court, 7th Judicial Circuit in and for St. Johns County. Case No. SP05-38, Division 66. April 27, 2005. Charles J. Tinlin, Judge. Counsel: David G. Candelaria, Farah, Farah & Abbott, P.A., Jacksonville. Edward Merrigan, Jacksonville.
ORDER GRANTING PARTIAL SUMMARY JUDGMENT FOR PLAINTIFF
This matter came before the Court for hearing on April 25, 2005, upon Plaintiff’s Motion for Final Summary Judgment. Although the Court does not find that the Plaintiff is entitled to Final Summary Judgment the Court does find that the Plaintiff is entitled to Summary Judgment on the issue of whether the 200% limitation contained in section 627.736(5)(b)(3) Florida Statutes applies to the electromyography treatment procedure.
Section 627.736(5)(b)(3) states in pertinent part that:
Allowable amounts that may be charged to a personal injury protection insurance insurer and insured for medically necessary nerve conduction testing when done in conjunction with a needle electromyography procedure and both are performed and billed solely by a physician . . .shall not exceed 200 percent of the allowable amount under the participating physician fee schedule of Medicare Part B. . .
Subparagraph (4) of that section goes on to state:
Allowable amounts that may be charged to a personal injury protection insurance insurer and issued for medically necessary nerve conduction testing that does not meet the requirements of subparagraph 3 shall not exceed the applicable fee schedule or other payment methodology established pursuant to Florida Statutes section 440.13.
The Court finds that the statute is unambiguous and that the 200% reduction applies only to medically necessary nerve conduction testing when done in conjunction with needle electromyography and not to a medically necessary electromyography testing procedure alone.
WHEREFORE, it is
ORDERED AND ADJUDGED that the Plaintiff’s Motion for Summary Judgment is GRANTED as to the issue above. The remaining issue for the Court’s determination is whether the billing amount for the electromyography procedure is medically reasonable.
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