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Insurance -- Personal injury protection -- Coverage -- Medical expenses -- Notice of claim -- Claim form -- CPT Code -- Video fluoroscopy -- No-Fault Law requires that provider comply with AMA CPT coding in submission of bills for payment of insureds' PIP benefits -- Insurer is not required to pay claim or charges with respect to bill that does not meet requirements of statute -- Court must turn to AMA CPT coding requirements and statutorily-referenced AMA promulgated guides when interpreting appropriate CPT code -- Since 2003, proper CPT code to be used when billing for video fluoroscopic procedures is 76120 -- AMA has specifically referenced that video fluoroscopic procedures performed under trade name Digital Motion X-Ray or by the procedural technology being described or utilized in the performance of a digital motion x-ray should be billed under 76120 -- By failing to use appropriate AMA CPT Code, provider failed to place insurer on notice of a covered loss -- Judgment granted in favor of insurer on its declaratory requests -- Provider's counterclaim seeking declaration that insurer acted improperly in its reimbursement determinations is denied -- Under policies at issue, insurer elected to reimburse 80% of reasonable expenses and provided that insurer could consider various federal and state medical fee schedules in determining reimbursement amount -- Evidence established that insurer was not limiting its reimbursement to an amount set by fee schedule, but rather considered fee schedule in determining reasonableness -- Provider failed to prove by greater and more persuasive standard that its $900 charge was reasonable -- Court declines to declare that insurer engaged in practice of downcoding provider's bills, and provider failed to prove by greater and more persuasive standard any bad faith on part of insurer -- Provider's counterclaim for declaration that insurer was required to contact provider prior to correcting what it believed to be a misrepresentative CPT code each time a bill was submitted by provider for Digital Motion X-ray, beginning in October 2003, is denied
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