Nothing gives me a bigger headache than reading about acupuncture and the fee schedule

Here are my top ten favorite arguments about why the chiropractor fee schedule should not be abided by.

1) There is no First Department case on point.  Mind you the Court of Appeals in LMK gave the DOI carte blanche to interpret any aspect of no-fault law via opinion letter.

2) The DOI’s opinion is unconstitutional.  This one is plainly absurd; and it is even more absurd when the Attorney General is not put on notice that a constitutional argument is being made.  I would impose $50 in motion costs each time this place in a motion or affirmation in opposition.

3) I can bill a separate code for each body region a needle is placed.

4) Acupuncturists have a superior educational level to that of chiropractors.  Is is that superior that they can bill $100 per acupuncture session?

5) Even the medical rate is too low and summary judgment should be denied.

6) You attached the 2007 fee schedule, even though the services were rendered in 2010.  Note – the fee schedule for acupuncture has not changed since the conversion from 97780 to 97810,et. al. in 2004.

7) It is a triable issue of fact because this issue should really go trial.

8 ) You cashed the payment for the partial reimbursement for acupuncture services, yet the denial (which accompanied the check) was never mailed

9) There is no fee schedule, so we can bill what we want.

10) We left the needles in for 20 minutes and therefore can bill for the act of reinsertion.

LVOV Acupuncture, P.C. v Geico Ins. Co., 2011 NY Slip Op 51721(U)(App. Term 2d Dept. 2011)

Anyway, here is an interesting case that evaluates certain arguments.

“We find that the workers’ compensation fee schedule, which is required by law (see Workers’ Compensation Law § 13) and incorporated by reference into the Insurance Department Regulations (see 11 NYCRR 68.1 [a]), is “of sufficient authenticity and reliability that it may be given judicial notice” (Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co., 61 AD3d 13, 20 [2009]; see also CPLR 4511 [b]). Defendant demonstrated that it had fully paid plaintiff for the services billed under codes 97810 and 97811 in accordance with the Official New York Workers’ Compensation Chiropractic Fee Schedule (see Great Wall Acupuncture, P.C. v GEICO Ins. Co., 26 Misc 3d 23 [App Term, 2d, 11th & 13th Jud Dists 2009]). Since plaintiff did not object to the fee schedule amount set forth by the defense, nor contest the timely denial of the claims, so much of defendant’s motion as sought summary judgment dismissing the complaint as to these claims is granted.”

Incorporated by reference = I do not need to attach it.

Also, did you see the initial visit, that was upheld in the amount of $160.56?  I have a thought about this one…