Key Takeaway
New York appellate court clarifies acupuncture billing rates, medical necessity proof standards, and scope of practice in no-fault insurance disputes.
No-fault insurance disputes involving acupuncture services often center on three critical issues: appropriate billing rates, medical necessity requirements, and scope of practice limitations. The Appellate Term’s decision in Gentle Care Acupuncture, P.C. v Geico Ins. Co. provides important guidance on all three fronts, establishing precedents that continue to influence how these cases are resolved.
Understanding the proper fee schedule for acupuncture services is crucial for both providers and insurers. When chiropractors perform acupuncture, questions arise about which billing rates apply and what constitutes appropriate reimbursement under New York’s no-fault system. Additionally, the burden of proof regarding medical necessity can determine whether treatments are covered, making it essential for providers to understand what documentation is required to defend against medical necessity challenges.
This case also addresses scope of practice issues, particularly regarding initial acupuncture visits and whether such services fall within a practitioner’s authorized treatment parameters under New York No-Fault Insurance Law.
Jason Tenenbaum’s Analysis:
Gentle Care Acupuncture, P.C. v Geico Ins. Co., 2010 NY Slip Op 52226(U)(App. Term 2d Dept. 2010)
The Court here followed prior precedent and held as follow: 1) Chiropractor rate for acupuncture prevails; 2) Insufficient proof of medical necessity will not defeat a lack of medical necesity motion; 3) The initial visit cannot be denied as being out-of-scope.
Key Takeaways
This decision reinforces that chiropractor billing rates apply when chiropractors perform acupuncture services, regardless of whether higher acupuncturist rates might exist. The court also emphasized that providers must present adequate proof of medical necessity to defend against insurer challenges - insufficient documentation will result in claim denials. Finally, initial acupuncture visits cannot be automatically rejected on scope-of-practice grounds when performed by qualified practitioners.
Legal Update (February 2026): Since this 2010 post, New York’s no-fault fee schedules have undergone multiple revisions, including updates to acupuncture reimbursement rates and billing code classifications. Additionally, regulatory amendments may have modified medical necessity documentation requirements and scope of practice parameters for acupuncture services. Practitioners should verify current fee schedule provisions and procedural requirements, as the cited rates and standards may no longer reflect applicable law.
