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

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

By Jason Tenenbaum 8 min read

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.


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

Common Questions

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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Attorney Jason Tenenbaum

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.

24+ years in practice 1,000+ appeals written 100K+ no-fault cases $100M+ recovered

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.

Filed under: Fee Schedule
Jason Tenenbaum, Personal Injury Attorney serving Long Island, Nassau County and Suffolk County

About the Author

Jason Tenenbaum

Jason Tenenbaum is a personal injury attorney serving Long Island, Nassau & Suffolk Counties, and New York City. Admitted to practice in NY, NJ, FL, TX, GA, MI, and Federal courts, Jason is one of the few attorneys who writes his own appeals and tries his own cases. Since 2002, he has authored over 2,353 articles on no-fault insurance law, personal injury, and employment law — a resource other attorneys rely on to stay current on New York appellate decisions.

Education
Syracuse University College of Law
Experience
24+ Years
Articles
2,353+ Published
Licensed In
7 States + Federal

Discussion

Comments (3)

Archived from the original blog discussion.

RZ
Raymond Zuppa
What about chiropratic manipulation while under the influence of marihuana or strong cold vodka?
RZ
Raymond zuppa
J.T. where do you see this line of cases going. Will there be reimbursement for psychological treatment of depression and anxiety brought on by the trauma of chiropractic manipulation. What other drugs do you see getting covered. Manipulation while under chrystal meth? Perhaps this will set precedent for a no fault fee schedule for medical marihuana.
J
JT Author
I cannot answer that question with a straight face Ray, except to say that you have too much free time on your hands. I will say that you give away the fact that you used to work in a District Attorney’s office because only a former criminal attorney versed in Article 221 of the New York Penal Law would spell marijuana as “marihuana”. Here is some trivia. Did you know that marihuana was previously found in Article 220 of the New York Penal Law before the 1977 amendments to New York’s drug laws? Also, did you know that the Rockefeller drug law as originally enacted, prior to the 1979 amendments, classified the sale or possession with intent to sell, of any narcotic drug as a class A-III felony – punishable by a mandatory life sentence, with a minimum of between 1 and 8 years?

Legal Resources

Understanding New York Fee Schedule Law

New York has a unique legal landscape that affects how fee schedule cases are litigated and resolved. The state's court system includes the Civil Court (for claims up to $25,000), the Supreme Court (the primary trial court for unlimited jurisdiction), the Appellate Term (which hears appeals from lower courts), the Appellate Division (divided into four Departments, with the Second Department covering Long Island, Brooklyn, Queens, Staten Island, and several upstate counties), and the Court of Appeals (the state's highest court). Each court has its own procedural requirements, local rules, and case-assignment practices that can significantly impact the outcome of your case.

For fee schedule matters on Long Island, cases are typically filed in Nassau County Supreme Court (at the courthouse in Mineola) or Suffolk County Supreme Court (in Riverhead). No-fault arbitrations are heard through the American Arbitration Association, which assigns arbitrators throughout the metropolitan area. Workers' compensation claims go to the Workers' Compensation Board, with hearings at district offices across the state. Understanding which forum is appropriate for your case — and the specific procedural rules that apply — is essential for a successful outcome.

The procedural landscape in New York also includes important timing requirements that can affect your case. Most civil actions are subject to statutes of limitations ranging from one year (for intentional torts and claims against municipalities) to six years (for contract actions). Personal injury cases generally have a three-year deadline under CPLR 214(5), while medical malpractice claims must be filed within two and a half years under CPLR 214-a. No-fault insurance claims have their own regulatory deadlines, including 30-day filing requirements for applications and 45-day deadlines for provider claims. Understanding and complying with these deadlines is critical — missing a filing deadline can permanently bar your claim, regardless of how strong your case may be on the merits.

Attorney Jason Tenenbaum regularly practices in all of these venues. His office at 326 Walt Whitman Road, Suite C, Huntington Station, NY 11746, is centrally located on Long Island, providing convenient access to courts and offices throughout Nassau County, Suffolk County, and New York City. Whether you need representation in a no-fault arbitration, a personal injury trial, an employment discrimination hearing, or an appeal to the Appellate Division, the Law Office of Jason Tenenbaum, P.C. brings $24+ years of real courtroom experience to your case. If you have questions about the legal issues discussed in this article, call (516) 750-0595 for a free, no-obligation consultation.

New York's substantive law also presents distinct challenges. In motor vehicle cases, the no-fault system under Insurance Law Article 51 provides first-party benefits regardless of fault, but limits the right to sue for non-economic damages unless the plaintiff establishes a "serious injury" under one of nine statutory categories. This threshold — codified at Insurance Law Section 5102(d) — requires medical evidence showing more than a minor or subjective injury, and courts have developed detailed standards for each category. Fractures must be documented through imaging studies. Claims of permanent consequential limitation or significant limitation of use require quantified range-of-motion testing with comparison to norms. The 90/180-day category demands proof that the plaintiff was unable to perform substantially all of their usual daily activities for at least 90 of the 180 days following the accident.

In employment discrimination cases, the legal standards vary depending on whether the claim arises under state or local law. The New York State Human Rights Law employs a burden-shifting framework: the plaintiff must first establish a prima facie case by showing membership in a protected class, qualification for the position, an adverse employment action, and circumstances giving rise to an inference of discrimination. The burden then shifts to the employer to articulate a legitimate, non-discriminatory reason for its decision. If the employer meets this burden, the plaintiff must demonstrate that the stated reason is pretextual. The New York City Human Rights Law, by contrast, applies a broader standard, asking whether the plaintiff was treated less well than other employees because of a protected characteristic.

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