Acupuncture – the fee schedule is incorporated by reference

Z.A. Acupuncture, P.C. v Geico Ins. Co., 2011 NY Slip Op 51842(U)(App. Term 2d Dept. 2011)

“ granted the branches of plaintiff’s motion as to the claims for services rendered between November 17, 2005 and January 19, 2006, because defendant did not submit the workers’ compensation fee schedule to the court”

“We find that the workers’ compensation fee schedule, which is mandated by law (see Workers’ Compensation Law § 13) and incorporated by reference into the Insurance Department Regulations (see 11 NYCRR 68.1 ), 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 ; see also CPLR 4511 ). Defendant demonstrated that it had fully paid plaintiff for the services rendered between November 17, 2005 and January 19, 2006 in accordance with the Official New York Workers’ Compensation Chiropractic Fee Schedule and that it had issued partial denials on that ground (see Great Wall Acupuncture, P.C. v GEICO Ins. Co., 26 Misc 3d 23 ). It is noted that defendant’s submissions also demonstrate that services billed under former fee schedule treatment code 97780, which at the time the services were rendered should have been billed under the new fee schedule treatment code, 97810, were properly re-coded accordingly. Consequently, the branches of defendant’s cross motion seeking summary judgment dismissing the complaint as to these claims are granted.”

Points of Health Acupuncture, P.C. v GEICO Ins. Co., 2011 NY Slip Op 51843(U)(App. Term 2d Dept. 2011)

Same as above.

LVOV Acupuncture, P.C. v GEICO, 2011 NY Slip Op 51844(U)(App. Term 2d Dept. 2011)

We find that the workers’ compensation fee schedule, which is mandated by law (see Workers’ Compensation Law § 13) and incorporated by reference into the Insurance Department Regulations (see 11 NYCRR 68.1 ), 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 ; see also CPLR 4511 ). 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

“Defendant did not proffer any evidence or argument to warrant the dismissal of plaintiff’s claim of $160.56 for the initial acupuncture visit on May 20, 2005, billed under fee schedule treatment code 99204”

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Legal Update (February 2026): Since this 2011 decision, the New York Workers’ Compensation fee schedules referenced in this acupuncture reimbursement case have undergone multiple revisions and updates. The specific treatment codes, reimbursement rates, and procedural requirements for acupuncture services may have been substantially modified through regulatory amendments. Practitioners should verify current fee schedule provisions and applicable treatment codes under the most recent versions of the Workers’ Compensation Law and Insurance Department Regulations.