Volume 18

18 Fla. L. Weekly Supp. 1177a

Online Reference: FLWSUPP 1811YOUN Insurance — Personal injury protection — Coverage — CPT coding — Insurer properly withheld payment for CPT code for evaluation and management performed on same date as chiropractic manipulation until and unless medical provider adds modifier required when both codes are billed on same date — Non-prescription drugs — Insurer is responsible for 80% of charge for non-prescription drugs furnished by provider — Although reimbursement for non-prescription drugs is not covered under Medicare Part B , statute allows for reimbursement for medical services not covered by Medicare Part B if service, supplies, or care is allowed under workers’ compensation, and applicable workers’ compensation reimbursement manual allowed for reimbursement to a dispensing practitioner for furnishing over-the-counter drugs

18 Fla. L. Weekly Supp. 222a

Online Reference: FLWSUPP 1802STEA Insurance — Personal injury protection — Coverage — Medical expenses — National Correct Coding Initiative edits, which bar physicians from administering certain services to patient on same day, are utilization limitations prohibited by PIP statute — Insurer is precluded from defending case on basis that CPT charges were unbundled or improperly coded where insurer waived those affirmative defenses by failing to plead them

18 Fla. L. Weekly Supp. 219a

Online Reference: FLWSUPP 1802GUAR

Insurance — Personal injury protection — Coverage — Medical expenses — National Correct Coding Initiative edits, which bar physicians from administering certain services to patient on same day, are utilization limitations prohibited by PIP statute — Insurer is precluded from defending case on basis that CPT charges were unbundled or improperly coded where insurer waived those affirmative defenses by failing to plead them

18 Fla. L. Weekly Supp. 96a

Online Reference: FLWSUPP 1801ALME Insurance — Personal injury protection — Coverage — Medical expenses — CPT coding — Medical provider cannot bill component treatment charge separately on same insured for same date of service as provider bills comprehensive treatment charge

18 Fla. L. Weekly Supp. 906b

Online Reference: FLWSUPP 1809JPER Insurance — Personal injury protection — Coverage — Consultation services — Where Medicare Part B fee schedule for consultation services no longer exists under own CPT code after 2010 change to Medicare CPT coding, but consultation services are still allowable Medicare Part B services under different coding, reimbursement is governed by Medicare fee schedule — Error to utilize workers’ compensation fee schedule to determine reimbursement as that fee schedule is only applicable to PIP claims when services are otherwise not reimbursable under Medicare Part B but are reimbursable under workers’ compensation fee schedule

18 Fla. L. Weekly Supp. 1182b

Online Reference: FLWSUPP 1811BAYF

Insurance — Personal injury protection — Coverage — Policy issued during statutory gap period — Where PIP policy was executed during statutory gap period when there was no PIP statute, mandatory policy language requiring that medical expenses be paid at 80% of reasonable charges controls over permissive statutory language allowing for reduced reimbursement

18 Fla. L. Weekly Supp. 907a

Online Reference: FLWSUPP 1809GUER Insurance — Personal injury protection — Coverage — PIP policy, which provides for payment of reasonable expenses, rather than version of PIP statute in effect at time of treatment, which provides for payment at reduced rate, governs reimbursement

18 Fla. L. Weekly Supp. 311a

Online Reference: FLWSUPP 1803THIE

Insurance — Personal injury protection — Coverage — PIP policy, which provides for payment of 80% of reasonable charges, rather than version of PIP statute in effect at time of treatment, which provides for payment of 80% of 200% of Medicare Part B fee schedule, is applicable where no PIP statute was in effect at time of policy execution, and statutory change is substantive

18 Fla. L. Weekly Supp. 301a

Online Reference: FLWSUPP 1803DEFR

Insurance — Personal injury protection — Coverage — Fee schedule in 2008 version of PIP statute is inapplicable where policy was issued prior to effective date of 2008 PIP statute, and plain language of policy required defendant to pay 80% of reasonable expenses rather than limiting payment in accordance with permissive language of 2008 PIP statute

18 Fla. L. Weekly Supp. 226a

Online Reference: FLWSUPP 1802BARR Insurance — Personal injury protection — Coverage — Where provision of 2008 PIP statute allowing insurer to limit reimbursement to 200% of Medicare fee schedule is permissive, clear and unambiguous policy language providing that insured will pay 80% of reasonable expenses controls reimbursement