Chiropractor? fee schedule applied to acupuncture

Understanding New York No-Fault Insurance: Chiropractor Fee Schedule Applied to Acupuncture Services

When dealing with New York no-fault insurance claims, medical providers and legal professionals across Long Island and New York City frequently encounter complex fee schedule disputes. The Law Office of Jason Tenenbaum has extensive experience navigating these intricate insurance law matters, particularly when it comes to understanding how different medical specialties are compensated under the state’s no-fault system. A recent appellate decision highlights the ongoing challenges faced by acupuncture providers seeking fair compensation for their services.

Case Analysis: Natural Acupuncture Health, P.C. v Praetorian Insurance Co.

Natural Acupuncture Health, P.C. v Praetorian Ins. Co., 2011 NY Slip Op 50040(U)(App. Term 1st Dept. 2011)

“Defendant made a prima facie showing of entitlement to judgment as a matter of law dismissing plaintiff Spring Medical, P.C.’s claims for assigned first-party no-fault benefits. Defendant established through the affidavit of its claims examiner and excerpts from the Workers’ Compensation Medical Fee Schedule, which may be judicially noticed by this Court (see Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co., 61 AD3d 13, 21 ), that the fees Spring charged for the medical services it rendered to the assignor exceeded the relevant rates set forth in the fee schedule. In opposition, Spring failed to raise a triable issue regarding [*2]defendant’s interpretation of the fee schedule or calculation of the applicable fees. Therefore, defendant’s motion for summary judgment dismissing Spring’s claims — which sought the difference between the amount Spring charged for the services and payments defendant made to Spring pursuant to the fee schedule — should have been granted (see Cornell Med., P.C. v Mercury Cas. Co., 24 Misc 3d 58 ).”

Note that in the First Department, the acupuncture fee schedule defense requires the annexing of the pertinent portions of the fee schedule and an explanation of why the chiropractor rate was chosen. Compare this to the Second Department standard where the court takes judicial notice that all an LAC is entitled to as a matter of law is the chiropractor rate.

By the way, I am just assuming the chiropractor rate was paid.

Mark my words. If Plaintiffs continue to push this issue in this Court, expect a broad based holding similar to that from the Second Department. This Court has no qualms about setting forth bright line rules when it sees the same issues before it – especially when they are related to PIP litigation.

The Significance of Departmental Differences in New York

This case underscores a critical aspect of New York’s legal landscape that affects personal injury attorneys throughout Long Island, Manhattan, Brooklyn, Queens, and the Bronx. The differences between how the First and Second Appellate Departments handle no-fault insurance disputes can significantly impact case outcomes for both medical providers and injured parties.

In the First Department, which covers Manhattan and the Bronx, insurance companies defending against acupuncture fee schedule challenges must provide more substantial evidence. They must annex relevant portions of the fee schedule and provide clear explanations for why chiropractor rates apply to acupuncture services. This requirement places a higher burden of proof on insurance companies and potentially offers more protection for acupuncture providers.

Conversely, the Second Department, which includes Long Island (Nassau and Suffolk Counties), Kings County (Brooklyn), Queens County, and Richmond County (Staten Island), has established a more restrictive standard. Courts in this jurisdiction take judicial notice that Licensed Acupuncturists (LACs) are only entitled to chiropractor rates as a matter of law, making it more challenging for providers to argue for higher compensation.

Impact on Medical Providers and Personal Injury Claims

For medical providers treating accident victims in the greater New York area, understanding these jurisdictional differences is crucial for business sustainability. Acupuncture practitioners must adjust their billing practices and expectations based on where their patients were injured and which appellate department will ultimately have jurisdiction over potential disputes.

From a personal injury perspective, these fee schedule limitations can indirectly affect the quality and availability of care for accident victims. When medical providers cannot recover adequate compensation for their services, it may limit their willingness to treat no-fault patients, potentially creating access to care issues for injured individuals.

Strategic Considerations for Legal Professionals

Personal injury attorneys practicing in New York must carefully consider venue and jurisdictional factors when advising clients and medical providers. The choice of where to file a case, when multiple venues are available, can significantly impact the outcome of fee schedule disputes.

Additionally, this case demonstrates the importance of thorough preparation when challenging insurance company fee schedule defenses. Medical providers and their attorneys must be prepared to address both the interpretation of the fee schedule and the calculation of applicable fees with specific, detailed evidence.

Frequently Asked Questions About No-Fault Insurance and Acupuncture

Q: Why are acupuncture services paid at chiropractor rates under New York no-fault insurance?

A: New York’s Workers’ Compensation Medical Fee Schedule, which is used as a reference for no-fault payments, does not have a separate fee schedule for acupuncture services. As a result, courts and insurance companies typically apply chiropractor rates to acupuncture treatments, as these are considered the most analogous services in the fee schedule.

Q: Can acupuncture providers challenge the application of chiropractor rates?

A: Yes, acupuncture providers can challenge these determinations, but success varies significantly depending on the jurisdiction. The First Department requires insurance companies to provide more detailed justifications, while the Second Department is more deferential to the chiropractor rate standard.

Q: How does this affect my personal injury case?

A: While fee schedule disputes primarily affect medical providers, they can indirectly impact your case by influencing the availability of certain types of medical care. Some providers may be less willing to treat no-fault patients if reimbursement rates are insufficient.

Q: What should I do if my medical provider is having difficulty getting paid by my no-fault insurer?

A: Contact an experienced personal injury attorney immediately. Delays in medical provider payments can complicate your treatment and recovery. An attorney can help ensure your medical providers are properly compensated and that your care continues without interruption.

Get Expert Legal Help with Your New York Personal Injury Case

If you’ve been injured in an accident and are dealing with no-fault insurance complications, or if you’re a medical provider facing fee schedule disputes, the Law Office of Jason Tenenbaum is here to help. Our experienced team understands the complexities of New York’s no-fault insurance system and has successfully handled thousands of cases throughout Long Island and New York City.

Don’t let insurance company tactics prevent you from getting the compensation you deserve or the medical care you need. Contact us today for a free consultation to discuss your case and learn about your legal options.

Call (516) 750-0595 now to speak with an experienced New York personal injury attorney.

We proudly serve clients throughout Nassau County, Suffolk County, Manhattan, Brooklyn, Queens, the Bronx, and all of New York State. With offices conveniently located on Long Island and extensive experience in New York City courts, we’re ready to fight for your rights and ensure you receive the maximum compensation available under the law.

Related Articles

• NY acupuncture providers face chiropractor rate limitations under prima facie defense rules
• Licensed acupuncture practitioners limited to chiropractor fee schedule rates
• Fee schedule defense requirements and competent evidence standards
• Understanding medical billing and down-coding practices in no-fault claims
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2011 post, New York’s no-fault fee schedules have undergone multiple revisions, including updates to both the Workers’ Compensation Medical Fee Schedule and specific no-fault reimbursement regulations that may affect how acupuncture services are categorized and compensated. Practitioners should verify current fee schedule provisions and any regulatory changes that may have modified the application of chiropractor schedules to acupuncture services.