Key Takeaway
The August 2009 Great Wall decision split the claims: one unpaid balance survived while other chiropractor-schedule reductions were upheld.
This article is part of our ongoing fee schedule coverage, with 118 published articles analyzing fee schedule issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
The insurer did not win every claim in this Great Wall appeal. Great Wall Acupuncture v GEICO, 2009 NY Slip Op 52308(U), decided August 31, 2009 and discussed here that November, left some reductions intact but awarded the provider the unpaid portion of a different claim.
Historical note: This August 2009 appeal applied the older rate and denial framework; DFS’s later acupuncture schedule guidance is essential before treating the headline’s chiropractor-rate statement as a rule for newer services.
Last reviewed: September 2026.
Two different outcomes in one appeal
For one claim, the insurer failed to establish a timely denial. The provider received summary judgment for the unpaid portion, with the matter remitted for interest and attorney’s fees. For the other claims, the insurer established proper payment under the chiropractor schedule and timely denials of the balances.
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The provider’s prevailing-local-rate argument did not defeat those supported reductions under the older acupuncture reimbursement framework. That does not mean geography never matters, or that every practitioner is now paid under the same schedule.
Read the title as historical
This post predates the later acupuncture schedule adoption described by DFS. It also predates the April 2013 excessive-fee amendment applied in Oleg’s Acupuncture. Do not carry its timely-denial outcome forward without checking the service dates and defense involved.
Nor does a fee reduction let the provider collect an unauthorized excess from the patient. Insurance Law § 5108(c) addresses that prohibition. The billing dispute and the patient’s medical care are separate issues; this appeal did not decide the safety of acupuncture.
Jason’s historical asides
These retained asides record Jason’s reaction, not findings about counsel’s identity or clinical safety. The EUO anecdote is not evidence that a particular acupuncture technique caused an injury:
So, despite the lower court’s order being modified, I offer congratulations to (I’ll guess) Spina’s office on this one.
Getting off-topic for a moment: how many of you have done an EUO and asked the EIP whether the acupuncturist missed the meridian and caused the EIP to bleed? I usually ask that question, and you would be surprised at the volume of affirmative responses.
Connect to the Encyclopedia
Start with the fee-schedule defense hub. Related case notes:
- Urban Well: coding corrections and separate necessity proof.
- OS Tigris: an unsupported fee-schedule defense.
- Great Wall: the November 2009 trial record.
- Live In Grace: the electrical-stimulation codes 97813 and 97814.
- Excel Surgery: New Jersey treatment and the service date.
- Healing Art: agreed coder testimony on codes 97810 and 97811.
For review of a particular no-fault billing dispute, contact the Law Office of Jason Tenenbaum. Bring the bill, service dates, denial and payment calculation.
Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Fee Schedule Issues in No-Fault Insurance
The New York no-fault fee schedule establishes the maximum reimbursement rates for medical treatment provided to injured motorists. Disputes over fee schedule calculations, coding, usual and customary charges, and the applicability of workers compensation fee schedules to no-fault claims are common. These articles analyze fee schedule regulations, court decisions on reimbursement disputes, and the practical challenges providers face in obtaining appropriate payment under the no-fault system.
118 published articles in Fee Schedule
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May 13, 2016Frequently Asked Questions
Common Questions About This Topic
5 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
Q: Are licensed acupuncturists always limited to chiropractor fee schedule rates in New York?
No. This post reports a 2009 decision under an older schedule regime. DFS identifies later acupuncture schedule adoption; the applicable rules depend on provider type and service date.
Q: Can acupuncturists in expensive areas like Manhattan charge higher rates due to increased overhead costs?
The provider's prevailing-rate argument failed on this record. That does not establish a universal rule ignoring geography; use the geographic provisions of the applicable schedule.
Q: What happens if my acupuncturist bills above the chiropractor fee schedule rates?
A billed excess is not automatically the patient's responsibility. Insurance Law § 5108(c) prohibits requesting payment beyond authorized charges; examine the bill and reduction rather than assuming balance billing is allowed.
Q: How can I ensure my acupuncture treatment is properly covered under no-fault insurance?
Confirm the coverage, provider, treatment records and applicable service-date rules. This fee appeal does not promise payment for every treatment or resolve medical necessity in a particular patient's case.
Q: What should I know about potential complications during acupuncture treatment?
The opinion did not decide a clinical complication. Discuss treatment risks or symptoms with a qualified clinician; Jason's historical EUO anecdote below is not medical evidence or advice.
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a fee schedule matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
