The chiropractor rate is all that an acupuncurist is entitled to

Legal Update: Acupuncture Now (2026) expressly applies the older comparison-rate rule to services before October 1, 2020. New Wave does not establish the applicable rate for later treatment.

Last reviewed: September 2026

New Wave Oriental Acupuncture v. GEICO concerned the older method of pricing licensed-acupuncturist services by reference to the chiropractic schedule. The Appellate Term denied the provider summary judgment in 2009. It expressly declined to award GEICO judgment. The opinion does not turn the trial checklist below into a guaranteed defense win.

The service date comes first

The 2009 opinion accepted the comparison schedule but left a triable dispute. A much later decision, Acupuncture Now v. MVAIC (2026), still used New Wave for services rendered before October 1, 2020. That express cutoff matters: an old conversion factor is not a current rate quote.

Connect the service dates, provider category, billed codes and applicable schedule to the payment calculation. A rate rule and sufficient proof of a particular defense are separate questions. DFS’s fee-schedule guidance explains the later acupuncture schedule adoption. It does not validate the historical calculator example for today’s treatment.

Jason’s historical commentary

Jason’s 2009 trial checklist is retained as historical commentary. The old conversion factor, predicted result and collection anecdote are not current rates, a court-mandated proof checklist or a promise of recovery:

The Appellate Term is starting to sound like a broken record. Yet, each time they play the record it seems that the message is more emphatic.

In New Wave Acupuncture v. Geico, 2009 NY Slip Op 52211(u)(App. Term 2d Dept. 2009), the Court stated the following: “For the reasons stated in Great Wall Acupuncture v GEICO Gen. Ins. Co. (16 Misc 3d 23 ), it was proper for defendant to use the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which plaintiff was entitled to receive.”

Note: The court as of this case and Ava Acupuncture v. Geico does not require the carrier to provide evidence as to why it chose to pay chiropractor fee schedule rate as opposed to another rate. The chiropractor fee schedule amount is acceptable as a matter of law. Period, the end.

Now, let’s assume that you are in a stipped in trial and the sole issue is whether or not the billing was in accordance with the “fee schedule”. Based on New Wave Acupuncture v. Geico and Ava Acupuncture v. Geico, this is what the defendant’s portion of the trial should look like:

Exhibit “A”

(1) Denial of claim form with explanation of benefits

Exhibit “B” .

(2) Fee schedule with CPT 97810, 97811, 97813, 97814;

Exhibit “C” .

(3) Chiropractor conversion factor ;

Exhibit “D” for identification:

(4) Shiny Sharpe brand Calculator

Exhibit “E” for reference: New Wave Acupuncture v. Geico and Ava Acupuncture v. Geico

(5) Give copies to the Judge and Plaintiff’s counsel.

(6) Tell Plaintiff and judge: “No, I do not need to bring a claim rep. This is why…”

(7) With calculator, take the relative value, multiply by the Region IV conversion factor of 5.78 and announce the result to the court. If you want, read the portion of the fee schedule that tells the court that this is how you arrive at the compensable amount. You will find this in the introduction section of the fee schedule.

Now, do this for each billed for code. Does the amount you calculated match the amount paid on the denial of claim form? If yes, go to next step.

(7) Motion for directed verdict.

(8a) If win smile

(8b) If lose APPEAL and do not forget to enter a judgment for costs and disbursements including the prospective marshal fee after the judgment is reversed without costs. The without costs only refers to appellate costs.

(8c) Tell the marshal you want to enforce the $105 judgment you just entered. See what the marshal says. I know first hand what you will be told. But, insist that the marshal collects the judgment. He is duty-bound to do this. I guarantee you will have a check in the mail in no time. One warning however: the next time you call that marshal, you will be told that you have the wrong number. Don’t worry – there are plenty of marshals out there.

Connect to the Encyclopedia

• Fee-schedule defense hub: cases, proof and later developments
• Liberty Chiropractic: conversion factors and unit proof
• Jodi Jacobs: showing that the right codes were used
• Giugliano: older cross-schedule billing and later restrictions
• Bronx Acupuncture (2019): the later verification decision
• Down-coding: the rule and evidence for a reduction

For review of a particular no-fault billing dispute, contact our office.