26 Fla. L. Weekly Supp. 670a
Online Reference: FLWSUPP 2608JGONInsurance — Personal injury protection — Coverage — Medical benefits — Unbundling — Provider that billed for electrical stimulation therapy was not entitled to separate payment for electrical stimulation pads incident to the procedure
FLORIDA PAIN AND WELLNESS CENTERS, INC. (As Assignee of Juan O. Gonzalez), Plaintiff, v. STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY, Defendant. County Court, 13th Judicial Circuit in and for Hillsborough County. Case No. 17-CC-021941, Division M. August 10, 2018. Herbert M. Berkowitz, Judge. Counsel: Timothy A. Patrick, Patrick Law Group, P.A., Tampa, for Plaintiff. Michael J. Wyatt and Edwin V. Valen, Cole, Scott & Kissane, P.A.,Tampa, for Defendant.
ORDER GRANTING DEFENDANT’S MOTIONFOR FINAL SUMMARY JUDGMENT
THIS CAUSE having come before the Court on June 6, 2018, on Defendant’s Motion for Final Summary Judgment and Plaintiff’s Amended Motion for Summary Judgment, and the Court having heard argument of counsel, and otherwise being advised in the Premises, the Court hereby finds as follows:
1. This is a Personal Injury Protection (“PIP”) case alleging breach of contract brought against Defendant, State Farm Mutual Automobile Insurance Company (“State Farm”), by Florida Pain and Wellness Centers, Inc. (“Plaintiff’) as assignee of Juan O. Gonzalez, (“Assignor”), for injuries allegedly sustained in a motor vehicle accident that occurred on September 29, 2016.
2. A central issue in this case involves the denial of CPT Code A4556 (electrodes) that was billed in conjunction with CPT Code G0283 on October 12, 2016, date of service.
3. Based on the affidavits of Jodi Verdi and Denisha Torres-Lich, and the medical records, Plaintiff was not compliant when coding and separately billing CPT Code A4556 for the October 12, 2016, date of service, as the electrical stimulation pads were provided for use during the same encounter as the performance of the electrical stimulation therapy, therefore, there is no separate payment for the electrical stimulation pads incident to the procedure.
4. Payment for the electrical stimulation pads supply was already included within the calculation for payment of the electrical stimulation procedure performed during the same encounter.
5. Therefore, additional payment would be considered unbundling and result in duplicative payment.
Therefore, considering the above facts, it is hereupon ORDERED AND ADJUDGED that:
1. Plaintiff’s Amended Motion for Summary Judgment is DENIED.
2. Defendant’s Motion For Final Summary Judgment is GRANTED.
3. Final Judgment is hereby entered in favor of Defendant State Farm Mutual Automobile Insurance Company.
4. The Plaintiff, Florida Pain and Wellness Centers, Inc., as assisgnee of Juan O. Gonzalez, shall take nothing by this action and the Defendant, State Farm Mutual Automobile Insurance Company, shall go hence without a day.
5. This Court reserves jurisdiction to consider any applicable claims for reasonable attorneys’ fees and costs, if any.
