Key Takeaway
Raz upheld dismissal of acupuncture treatment claims but left an initial-visit dispute unresolved. A 2010 case note with the later schedule boundary.
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.
Raz Acupuncture v AIG (2010) produced a split result. The insurer kept its dismissal of the acupuncture treatment claims, but it did not obtain dismissal of the initial-visit claim. The provider did not win summary judgment on that visit either.
Legal Update (September 2026): Acupuncture Now (2026) expressly applies the comparison-rate rule to pre-October-2020 services; Raz’s 2010 treatment ruling does not supply the rate for later treatment.
Last reviewed: September 2026
Treatment payments and the initial visit
The insurer had paid the treatment claims using the physician acupuncture schedule, which the court described as higher than the chiropractic comparison rate it permitted under Great Wall. The Appellate Term therefore left dismissal of those treatment claims intact.
Free Consultation · No Fee Unless We Win
Does this apply to your situation?
Every case is different. Get a free, confidential case review from an experienced attorney who can tell you exactly where you stand.
For the initial visit, the insurer’s assertion that the service was not compensable did not establish its entitlement to dismissal. But that failure did not supply the provider’s missing proof. The provider’s cross-motion also failed because its submission did not establish the claim forms as admissible business records.
Why the distinction matters
The insurer moved for summary judgment; the provider cross-moved. Reversing those roles makes the opinion appear to say the opposite of what happened. Raz did not reject acupuncture fee-schedule defenses generally or direct payment of every initial visit.
Jason’s sardonic comparison below concerns the weakness of the particular noncompensability argument. The court did not impose sanctions for the positions discussed here. For the old treatment rates, the service-date qualification in the update above remains essential.
Jason’s historical commentary
These are Jason’s original observations from 2010. The first concerns the old comparison-rate rule; the second criticizes the insurer’s initial-visit proof. Neither means the provider won payment of that visit:
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.
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.
Connect to the Encyclopedia
Fee-schedule defense topic hub
- Okslen: a physician-schedule ceiling, not a provider victory
- Oriental World: dismissal under Great Wall
- Sung Bok Lee: the comparison schedule upheld
- S.O.V.: treatment codes and unresolved claims
For review of a particular bill or denial, contact the firm. The decision and commentary above concern the stated record; they do not determine a new claim.
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
Keep Reading
More Fee Schedule Analysis
Acupuncture Reimbursements and Insurance Legalities Explained
Explore the Forrest Chen v. GEICO case and its impact on acupuncture insurance reimbursements in NY. Key insights for providers and patients.
Dec 11, 2024
Simple addition is insufficient
Jodi Jacobs's 2021 mixed appeal: four claims dismissed, one fee balance unresolved, and why the schedule alone did not prove correct code use.
May 22, 2021
The chiropractor rate
S.O.V. granted partial dismissal of 2015–2016 acupuncture claims. Read the code and service-date exceptions and the later fee-schedule boundary.
Sep 25, 2020
Acupuncture that is broken down by code
Court decision analysis on acupuncture billing codes in NY no-fault insurance cases, examining fee schedule defenses and discovery requirements for CPT codes 97810 and 97811.
Oct 2, 2017
Acupuncture may be billed using 97039 and 97026
NY court ruling on acupuncture billing codes 97039 and 97026 in no-fault insurance claims, establishing fee schedule guidelines for licensed acupuncturists.
Mar 19, 2015
More MUA – this one is over the top
Court case analysis examining chiropractor MUA billing disputes under NY no-fault fee schedules, including rate limitations and multiple procedure rules.
Mar 28, 2012Was this article helpful?
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.
