Key Takeaway
Civil Court ruling confirms chiropractors can bill for manipulation under anesthesia (MUA) services in no-fault insurance claims with specific rate limitations.
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.
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.
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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.
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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Frequently Asked Questions
What is the no-fault fee schedule?
New York's no-fault fee schedule, established by the Workers' Compensation Board and the Department of Financial Services, sets the maximum reimbursement rates that no-fault insurers must pay for medical services. When an insurer pays less than the billed amount, citing the fee schedule as a defense, the provider can challenge the reduction by demonstrating that the fee schedule was improperly applied or that the services are not subject to fee schedule limitations.
Can a medical provider charge more than the fee schedule allows?
Medical providers treating no-fault patients are generally limited to the amounts set by the fee schedule and cannot balance-bill the patient for the difference. However, certain services may not be covered by the fee schedule, and disputes about whether a specific service falls within the fee schedule are common in no-fault litigation. The Department of Financial Services periodically updates the fee schedule rates.
How are fee schedule disputes resolved in no-fault arbitration?
When an insurer partially pays a claim citing the fee schedule, the provider can challenge the reduction through no-fault arbitration. The provider must demonstrate that the service billed is not subject to the fee schedule or that the fee schedule was incorrectly applied. The insurer bears the burden of proving the fee schedule applies and the correct rate was used. Fee schedule disputes often involve coding issues, modifier usage, and applicability of Workers' Compensation rates.
Does the no-fault fee schedule apply to all medical services?
Not all medical services are subject to the no-fault fee schedule. Certain services, supplies, and procedures may fall outside its scope, in which case the provider may bill the usual and customary rate. Disputes about whether a specific service or billing code is covered by the fee schedule are common. The Workers' Compensation Board fee schedule and the Department of Financial Services ground rules guide which services are covered and at what rates.
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About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
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.
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