26 Fla. L. Weekly Supp. 58a
Online Reference: FLWSUPP 2601JEANInsurance — Personal injury protection — Coverage — Massage benefits — Licensed massage therapist services provided to a non-LMT owned and duly licensed healthcare clinic and provided under CPT codes other than CPT Code 97124 and are reimburseable
NORTH MIAMI THERAPY CENTER, INC. (a/a/o Mona Jean-Paul), Plaintiff, v. GEICO GENERAL INSURANCE COMPANY, Defendant. County Court, 17th Judicial Circuit in and for Broward County. Case No. 14-002512 COCE (54). January 23, 2018. Florence T. Barner, Judge. Counsel: Susan Guller, The Law Offices of Justin G. Morgan, P.A., Weston, for Plaintiff. George Gomez, Herssein Law Group, North Miami, for Defendant.
ORDER ON GEICO’S MOTION FOR SUMMARY JUDGMENTBASED ON MASSAGE AND LMT SERVICES ASNON-REIMBURSABLE AND MOTION FOR SUMMARYJUDGMENT AND ON PLAINTIFF’S MOTION FOR FINALSUMMARY JUDGMENT ON LMT BILLED SERVICES ASREIMBURSABLE, MEDICAL NECESSITY AND RELATEDNESS
THIS CAUSE having come before the Court on Plaintiff’s Motion for Final Summary Judgment on LMT Billed Services as Reimbursable, Medical Necessity and Relatedness, and Defendant’s Motion for Summary Judgment Based on Massage and LMT Services as Non-Reimbursable and Motion for Summary Judgment, and the Court having reviewed the pleadings, having heard argument of counsel, and being otherwise fully advised in the premises, it is hereupon ORDERED and ADJUDGED, as follows:
1. Plaintiff’s Motion for Final Summary Judgment on LMT Billed Services as Reimbursable, Medical Necessity, and Relatedness is GRANTED.
2. Plaintiff established its prima facie case on the bills being related and medically necessary through filing the Affidavits of its Billing Clerk and Records Custodian, Claude Jules, attaching the Assignment of Benefits and bills at issue, and by filing the Affidavit of the treating Chiropractor, Dr. Robert Gordon, who attested to the treatment being both medically necessary and related to the accident at issue.
3. Defendant failed to submit any admissible evidence to oppose medical necessity or relatedness. Defendant’s ore tenus request for the Court to reserve decision until the treating Chiropractor, Dr. Robert Gordon, could be deposed is hereby denied.
4. The issue of the Licensed Massage Therapist (LMT) billed services is a matter of first impression for this Court as to whether LMT services provided on behalf of a non-LMT owned, and duly licensed healthcare clinic, are reimbursable under §627.736(1)(a)(5), Fla.Stat.
5. Plaintiff stipulated to reasonableness based upon the Medicare Fee Schedule/Workers Compensation Fee Schedule.
6. The Court finds that while §627.736(1)(a)(5), Fla.Stat generally prohibits a Licensed Massage Therapist from recovering for massage and for medical benefits, in the instant matter the LMT services billed by Plaintiff are compensable and reimbursable as the LMT’s performing the services were not the billing entity, but rather employees of Plaintiff, a duly licensed, separate incorporated entity, responsible for the billing and services rendered.
7. Plaintiff had previously withdrawn from consideration CPT Code 97124 for massage therapy, so massage therapy was not at issue.
8. Plaintiff set forth, through Dr. Gordon’s Affidavit, that the remaining CPT Codes at issue provided by the LMT, were not massage therapy. Defendant filed nothing to oppose this.
9. Defendant’s Motion for Summary Judgment and its Motion for Summary Judgment Based on Massage and LMT Services as Non-Reimbursable are hereby DENIED.
10. Plaintiff is owed PIP benefits for all bills at issue reduced pursuant to the applicable fee schedule, pre-judgment interest, and reasonable attorney’s fees and costs.
