17 Fla. L. Weekly Supp. 465a
Online Reference: FLWSUPP 1706AYERInsurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Insurer erred in denying payment for claimed CPT code that appears on Medicare Part B durable medical equipment fee schedule
FLORIDA MEDICAL & INJURY CENTER, INC., as assignee of Kyle Ayers, Plaintiff, vs. PROGRESSIVE SELECT INSURANCE COMPANY, Defendant. County Court, 9th Judicial Circuit in and for Osceola County. Case No. 09-CC-1053-CL. January 14, 2010. Ronald A. Legendre, Judge. Counsel: Michael Tierney, Winter Park. Neil Andrews, Orlando.
ORDER ON DEFENDANT’S AMENDED MOTION FOR SUMMARY JUDGMENT
THIS CAUSE having come before the Court on January 11, 2010, and the Court having reviewed the Motion(s) and being otherwise duly advised in the premises, it is hereby
ORDERED AND ADJUDGED:
1. Count I of Defendant’s Amended Summary Judgment regarding the Health Care Provider Cerification of Eligibility for PIP Benefits Form is denied.
2. Count II of Defendant’s Amended Summary Judgment regarding reimbursement of CPT code A4556 is DENIED. Plaintiff billed Defendant for supply CPT code A4556 (electrodes) provided to Defendant’s insured on date of service 12/16/08. Defendant denied payment of supply CPT code A4556 and moved for summary judgment on the basis that this code is not listed under the Participating Physician’s fee schedule for Medicare Part B nor the Worker’s Compensation Reimbursement Manual for 2008, and thus it is not reimbursable. CPT code A4556 is listed in the Durable Medical Equipment Prosthetics/Orthotics and Supplies (DME) fee schedule under Medicare Part B. Defendant argued the DME schedule was not the proper fee schedule to determine reimbursement for CPT code A4556.
