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Acupuncture Fee Schedule Disputes: When Settled Law Remains Contested

Fee schedule disputes represent a recurring battleground in New York no-fault insurance litigation. When courts repeatedly establish clear legal principles, one might expect compliance from insurers and an end to litigation over settled issues. However, as this case demonstrates, some legal questions continue generating disputes despite abundant precedent establishing the governing rules.

Acupuncture reimbursement rates have been particularly contentious. Licensed acupuncturists provide valuable medical services to accident victims, yet questions persist about appropriate reimbursement levels under New York’s fee schedule framework. The Appellate Term, Second Department has addressed this issue multiple times, consistently holding that acupuncture services are reimbursable at the chiropractor rate established in the workers’ compensation fee schedule.

Despite this clear precedent, insurers continue attempting to apply lower reimbursement rates or deny coverage entirely for acupuncture services. This pattern raises questions about whether continued litigation reflects good-faith legal disputes or strategic delay tactics designed to avoid payment obligations. The frequency of these cases also suggests systemic issues in how some insurers process acupuncture claims.

Case Background

Raz Acupuncture, P.C. sued AIG Indemnity Insurance Co. seeking payment for acupuncture services provided to an accident victim covered under AIG’s no-fault policy. AIG apparently reimbursed these services at a rate higher than the chiropractor fee schedule, specifically using the fee schedule for acupuncture services performed by medical doctors. Despite paying at this higher rate, litigation ensued over the appropriate reimbursement standard.

The provider moved for summary judgment, and AIG cross-moved, apparently asserting that acupuncture services were either not compensable or should be reimbursed at some other rate. The Appellate Term, Second Department reviewed the competing positions.

Jason Tenenbaum’s Analysis:

Raz Acupuncture, P.C. v AIG Indem. Ins. Co., 2010 NY Slip Op 51177(U)(App. Term 2d Dept. 2010)

It gets to the point where enough is enough. The Appellate Term, Second Department, has repeatedly held that acupuncture services are reimbursable, as a matter of law, at the chiropractor rate. The Court in the case stated the following:

“This court has held, “as a matter of law, that an insurer may use the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to receive for such acupuncture services” (Great Wall Acupuncture, P.C. v Geico Ins. Co, 26 Misc 3d 23, 24 ). As it is undisputed that defendant paid plaintiff based upon the workers’ compensation fee schedule for acupuncture services performed by a medical doctor, a rate higher than that established for acupuncture services performed by a chiropractor, we decline to disturb so much of the order as granted defendant summary judgment dismissing plaintiff’s complaint with respect to those claims.”

What is somewhat new is that the Appellate Term has held that the “it is not compensable” defense for failing to pay an initial acupuncture visit shares the same level of validity as the “it is included in the comprehensive visit” defense for failing to pay for computerized range of motion. For those of you who do not get this sardonic humor, it is sufficient to say that there is no validity to this statement.

Legal Significance: Repeated Holdings and Stare Decisis

The Raz Acupuncture decision reinforces precedent that should have ended fee schedule disputes for acupuncture services years earlier. When appellate courts repeatedly hold that specific fee schedules apply to particular services, these holdings become binding precedent that lower courts and litigants must follow. The doctrine of stare decisis promotes stability and predictability in law by requiring adherence to established principles.

Yet this case illustrates how settled law can remain contested terrain. Insurers may continue litigating issues hoping for different outcomes, testing whether new panels might diverge from prior precedent, or simply delaying payment obligations through protracted litigation. While parties have rights to present legal arguments, repeatedly asserting positions foreclosed by precedent strains judicial resources and increases litigation costs.

The court’s citation to Great Wall Acupuncture establishes the controlling principle: insurers may use the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine appropriate reimbursement for licensed acupuncturists performing those same services. This rule provides clarity about reimbursement calculations and prevents discrimination between similarly situated providers.

Jason Tenenbaum’s observation about the “not compensable” defense highlights how insurers sometimes advance legally baseless positions. Comparing this defense to the discredited “included in comprehensive visit” argument for range of motion testing emphasizes the lack of legal support for denying acupuncture coverage entirely.

Practical Implications

Licensed acupuncturists and their attorneys should recognize that fee schedule defenses to their claims have been repeatedly rejected by New York courts. When insurers underpay or deny acupuncture services, providers have strong legal grounds to pursue full reimbursement at the chiropractor rate. Summary judgment motions citing binding precedent like Great Wall and Raz should succeed absent factual disputes about services rendered.

Insurance carriers should reassess their acupuncture payment practices in light of consistent appellate holdings. Continuing to litigate settled legal issues may expose insurers to attorney fee awards under Insurance Law section 5106, which permits fee recovery when insurers fail to pay overdue claims without reasonable basis. Implementing accurate automated payment systems for acupuncture claims would reduce litigation exposure while ensuring regulatory compliance.

Trial courts facing these recurring disputes should expedite resolution through early dismissal or summary judgment. When controlling precedent clearly establishes payment obligations, protracted litigation serves no legitimate purpose. Courts may appropriately impose costs or sanctions when parties repeatedly assert positions foreclosed by binding authority.

Related Articles

• NY Acupuncture Fee Schedules: Licensed Practitioners Limited to Chiropractor Rates
• NY Acupuncture Prima Facie Defense: Chiropractor Rate Limitations Upheld
• Fee Schedule Defense Requirements in No-Fault Insurance Cases
• Understanding Medical Billing and Down-Coding in New York No-Fault Insurance Claims
• New York No-Fault Insurance Law

Legal Update (February 2026): The fee schedules and reimbursement rates for acupuncture services referenced in this 2010 post have been subject to multiple regulatory updates and amendments since publication. Practitioners should verify current fee schedule provisions and any changes to the workers’ compensation fee schedule structure that may affect acupuncture reimbursement rates under no-fault insurance policies.