This column analyzes a recent decision in which a physician established a relative value to bill for services but did not provide a supporting report justifying that value, as well as recent decisions that involved vacating arbitration awards.
‘By Report’ Codes
Pursuant to Insurance Law §5108 and No-Fault Regulation 68.1,1 the applicable no-fault insurance fee schedule for medical services is the Worker’s Compensation Fee Schedule (fee schedule). Most services contained in the fee schedule are assigned a relative value, which, when multiplied by the applicable conversion factor,2 results in the allowable fee. There are, however, a number of services that are not assigned a relative value, but, instead, are designated “by-report” items. General Ground Rule 3 of the fee schedule provides, in pertinent part:
