A chiropactor may bill for manipulation under anethesia services – but you knew that already

A Civil Court in a published decision rebuked an ill-fated, ill-conceived and senseless challenge to the proposition that a chiropractor may perform and bill for MUA services.

John Giugliano, DC, P.C. v Merchants Mut. Ins. Co., 2010 NY Slip Op 20308 (Civ. Ct. Kings Co. 2010)

While I might have my own personal misgivings about the MUA procedure and how it is being performed in the no-fault world, a chiropractor may bill for it.  I can discuss here how some of the MUA procedures I see being done should be reported to the Department of Education or OPM.  Yet, that is not the purpose of this discussion.

The reason why the defense practitioner in this case was way off the mark in defending this matter, is based upon an opinion letter, dated 8/14/09 from the general counsel of the Workers’ Compensation Board, Kenneth J. Munnelly, which says this:

“For example, if an appropriately trained chiropractor performs MUA, then that chiropractor can bill under the pertinent codes.  The CPT Codes most commonly billed under are 22505 and 27275. The relative value unit (RVU) is established for such CPT codes by the official medical fee schedule and remains constant whether a medical doctor, osteopathic doctor or chiropractor bills for that service using that code. The reimbursement rate, however, differs based upon the conversion factor assigned to the type of provider. The comparison of conversion factors that an osteopathic doctor would bill versus the factor under which a chiropractor would bill indicates that the chiropractor should be billing and get paid at 68.4% of the allowable conversion factor for the medical and osteopathic doctors performing the same procedure.”

You can find this letter in various arbitration decisions, e.g., AAA # 412010007480.  I am still looking for a copy of the actual letter.

We can all agree, I think, that an opinion letter from the agency that is in charge of the fee schedule, which says that a chiropractor may bill for MUA services, ends the debate.

But I also have similar misgivings about why Plaintiff did not make a summary judgment motion, or even bothered calling a rebuttal witness at the trial in this matter.  The facts of this case did not present any factual issues; it involved an issue of law that was properly decided adversely to the insurance carrier.

I mean if an insurance carrier -justifably- can waive an opinion letter and create Fogel and Great Wall, then why is this any different?  The shoe was on the other foot in this case.  It happens.

Related Articles

• 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
• NY Acupuncture Fee Schedules: Licensed Practitioners Limited to Chiropractor Rates
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2010 post, New York’s no-fault fee schedules and reimbursement rates have undergone multiple revisions, including changes to CPT code valuations, conversion factors, and provider-specific billing parameters. Additionally, regulatory guidance regarding manipulation under anesthesia services and provider qualifications may have been updated through subsequent Workers’ Compensation Board opinions or Department of Financial Services regulations. Practitioners should verify current fee schedule provisions and billing requirements before relying on the reimbursement standards discussed in this older post.