Key Takeaway
NY acupuncture reimbursement case: Appellate Term rules on proper billing codes 97810, 97811 and initial consultation fees under no-fault insurance law.
Olga Bard Acupuncture, P.C. v Geico Ins. Co., 2010 NY Slip Op 51898(U)(App. Term 2d Dept. 2010)
This is an interesting case because the Appellate Term actually listed two of the four properly used acupuncture codes, and discussed an initial consultation code. These codes involved: 97810, 97811 and an initial consultation code.
“Consequently, so much of plaintiff’s motion as sought summary judgment on the second and third causes of action as well as the remaining portion of the first cause of action should have been denied, and so much of defendant’s cross motion as sought summary judgment dismissing the second and third causes of action and the remaining portion of the first cause of action should have been granted, as these causes of action sought to recover upon claims that were paid pursuant to the workers’ compensation fee schedule (see Great Wall Acupuncture, P.C., 26 Misc 3d 23; Great Wall Acupuncture, 16 Misc 3d 23).”
Therefore, “so much of plaintiff’s motion as sought summary judgment as to the second and third causes of action and as to claims bearing codes 97810 and 97811 included in the first cause of action is denied, so much of defendant’s cross motion as sought summary judgment dismissing the second, third, fourth and fifth causes of action as well as so much of the first cause of action as sought to recover for claims bearing codes 97810 and 97811 is granted…”
“However, defendant did not proffer sufficient evidence to warrant the dismissal of plaintiff’s claim in the sum of $109.34 for the initial acupuncture visit, which claim was included in plaintiff’s first cause of action”
Related Articles
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- 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): Since this 2010 post, New York’s no-fault fee schedules and acupuncture reimbursement provisions have been subject to multiple regulatory amendments and updates. The specific CPT codes, reimbursement rates, and fee schedule methodologies referenced in this case may no longer reflect current law. Practitioners should verify current fee schedule provisions and applicable reimbursement rates with the most recent regulatory guidance.
