Chiropractor? fee schedule applied to acupuncture

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

The caption says Natural Acupuncture Health, but the fee-schedule portion of this appeal concerned Spring Medical. The insurer won dismissal of Spring’s claims and did not win dismissal of Right Aid Diagnostic Medicine’s separate medical-necessity claim. Those limits matter more than a broad statement that one appellate department pays acupuncture differently.

Legal Update (September 2026): The acupuncture fee schedule took effect for no-fault services from October 1, 2020; this January 2011 opinion did not identify a chiropractor rate as its holding, and the fee-schedule hub places it among the older proof decisions.

Last reviewed: September 2026.

Which claims were actually before the appellate court?

Natural Acupuncture Health, P.C. v Praetorian Insurance Co., 2011 NY Slip Op 50040(U), was decided January 14, 2011, by the Appellate Term, First Department. Several provider claims appeared in the caption. The insurer’s appeal addressed the denial of summary judgment on the claims of Spring Medical and Right Aid Diagnostic Medicine.

The court modified the order to dismiss Spring Medical’s claims. Praetorian had supplied its claims examiner’s affidavit and excerpts from the workers’ compensation medical fee schedule. That proof established that the charges exceeded the relevant schedule rates. Spring did not raise a triable issue about the insurer’s interpretation or calculation.

The decision does not identify the particular services or state that the court chose a chiropractor rate for a licensed acupuncturist. The caption alone does not establish either fact. Jason expressly described the rate as an assumption in his original note, preserved below.

The separate medical-necessity branch

Right Aid’s claim had a different outcome. The insurer did not establish timely denial or a proper verification request tolling the denial period. The court therefore left the denial of the insurer’s summary-judgment motion on that claim in place.

That was not a finding that all treatment in the case was medically necessary. It was a failure of the insurer’s motion proof on timeliness. The court also noted that Right Aid’s reply affirmation could not establish its own prima facie entitlement to summary judgment.

The distinction matters when reading a multi-provider caption. A fee-schedule victory for one claim does not decide a medical-necessity defense to another. Nor does leaving a claim unresolved necessarily award the provider payment. The Shara case note supplies another example in which the appellate court treated different portions of a provider’s bill separately.

Jason’s 2011 commentary, with its assumption intact

The following is Jason’s contemporaneous comparison of the departments. His prediction and assumed rate are historical commentary, not findings added to the published decision.

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 original prediction should not become a current instruction to select a court based on an assumed acupuncture rate. This particular opinion identifies sufficient proof for Spring Medical’s claims; it does not establish the sweeping departmental rule described in the earlier surrounding copy.

What the judicial-notice reference adds

The court cited Kingsbrook Jewish Medical Center v Allstate, 61 AD3d 13, when discussing its ability to take judicial notice of the fee-schedule materials. Praetorian nevertheless submitted excerpts and an examiner’s affidavit. The payment conclusion was tied to that record.

The practical distinction is between finding the governing schedule and proving its application. A court’s ability to consult a regulation does not explain an unexplained reduction, establish a payment that was never documented or resolve a genuinely disputed coding fact.

Compare MIA Acupuncture v Integon, where the insurer established full payment and timely denial through the affidavits described in the opinion, with Healing Art v Amica, where a vendor’s fee-schedule adjuster supported the calculation. Those cases help identify the evidentiary task. They do not supply an automatic result based on an affiant’s employer or professional title.

The cited codes case was not an acupuncture price decision

Kingsbrook involved a hospital bill and an insurer’s argument that the coded diagnoses showed treatment unrelated to the accident. The court allowed judicial notice of the official federal code definitions, but those definitions did not establish the medical conclusion the insurer wanted.

No qualified medical expert had supplied the necessary causal analysis. The court therefore affirmed the hospital’s summary judgment on the claim before it despite accepting the reliability of the code key. That is an important limit on what “judicial notice” accomplished in the cited authority.

Natural Acupuncture Health cited Kingsbrook when discussing schedule materials, then relied on the examiner’s affidavit and excerpts for Spring Medical’s fee calculation. The citation did not make a medical inference or a contested reimbursement calculation self-proving.

Read together, the decisions distinguish access to reliable reference material from proof of a disputed fact. A reader who can identify a code still needs to know what proposition the evidence establishes: the meaning of the code, the amount permitted for the service, or the relationship between treatment and an accident. These are not the same evidentiary question.

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: That question reflects the older disputes in this archive, not a universal current rule. The specified acupuncture schedule amendments became applicable to no-fault services from October 1, 2020. For older services, the cited cases considered the then-applicable framework. Natural Acupuncture Health itself did not identify the rate as the chiropractor rate.

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

A: A provider can dispute a reduction’s legal or factual basis, but the service date, applicable schedule and actual evidence matter. This opinion does not establish that a provider wins or loses solely because the action is in one appellate department. Spring Medical lost because the insurer established its calculation and Spring did not raise a triable issue.

Q: How does this affect my personal injury case?

A: This appeal concerned assigned medical-provider bills, not the value of an injured person’s tort claim. A provider’s reimbursement dispute and a patient’s claim against an allegedly responsible party are different matters. The opinion does not find that reimbursement rates caused treatment shortages or changed the quality of anyone’s care.

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

A: Obtain the bill, the insurer’s payment explanation and any denial so the reason for nonpayment can be identified. Ask whether the dispute concerns the amount, necessity, coverage or another issue. A fee reduction alone is not proof that the patient owes the difference; the assignment and applicable billing rules must be reviewed.

Keep the older case attached to the right issue

The value of this note is its two-part outcome and Jason’s candid record of what he was assuming. It belongs beside the library’s proof-of-payment cases, rather than standing alone as a current acupuncture reimbursement chart.

For later fee-preclusion issues, follow the Saddle Brook excessive-fee amendment note. For the office-based facility-fee distinction, Avanguard addresses whether the separate fee was reimbursable at all. A dispute over amount, a dispute over medical necessity and a dispute over entitlement to a separate category of fee require different authorities.

Connect to the Encyclopedia

Start with the fee-schedule defense hub. Follow the closest case comparisons:

• MIA Acupuncture: the insurer proved payment and won the appeal.
• Healing Art: vendor evidence supported the payment calculation.
• Shara: separate treatment codes and an initial evaluation.
• Saddle Brook: a later amendment affected fee-defense preclusion.
• Avanguard: a facility-fee entitlement question, not an acupuncture rate.

For review of a particular no-fault billing dispute, contact the Law Office of Jason Tenenbaum. Bring the service dates, bills, payment records, denials and the insurer’s fee calculation. A review can identify the disputed issue; these historical decisions do not guarantee a recovery.