Key Takeaway
New York appellate court reinforces requirement for insurance carriers to properly submit fee schedules as evidence in acupuncture reimbursement disputes under no-fault law.
The proper application of fee schedules in acupuncture reimbursement cases continues to be a complex area of New York no-fault insurance law. While carriers often assume they can rely on standard physician or chiropractic fee schedules for acupuncture services, recent appellate decisions have highlighted critical procedural requirements that can make or break a summary judgment motion.
The workers’ compensation fee schedule has become increasingly relevant in acupuncture billing disputes, particularly when carriers seek to justify reduced payments for services. However, as various recent cases demonstrate, carriers must follow strict evidentiary requirements when moving for summary judgment - including proper annexation of the applicable fee schedules in their court papers.
Jason Tenenbaum’s Analysis:
MIA Acupuncture, P.C. v Integon Gen. Ins. Corp., 2012 NY Slip Op 50393(U)(App. Term 2d Dept. 2012)
“the portion of plaintiff’s claims at issue based upon the workers’ compensation fee schedule. Moreover, defendant demonstrated that it had fully paid plaintiff for the acupuncture services billed for, in accordance with the workers’ compensation fee schedule”
I included this case because there have been a few acupuncture fee schedule cases floating around lately that have denied insurance carrier’s motions for summary judgment, despite what appeared to be reimbursement in accordance with the chiro or physician fee schedule. From what I have discerned through various conversations with counsel for the various carriers is that the App. Term is enforcing the “you must ask for judicial notice rule” or the rule that the carrier must annex the proper fee schedule the moving or answering papers.
This case proves, on some level, that point.
Key Takeaway
The MIA Acupuncture case reinforces a crucial procedural requirement in no-fault litigation: carriers must properly annex relevant fee schedules to their court papers rather than assuming courts will take judicial notice. This evidentiary requirement has become a decisive factor in recent acupuncture billing disputes, with carriers losing otherwise strong summary judgment motions due to procedural oversights.
Legal Update (February 2026): Since this 2012 analysis, New York’s no-fault fee schedules and acupuncture reimbursement regulations have likely undergone multiple revisions, including potential updates to workers’ compensation fee schedule provisions and procedural requirements for summary judgment motions. Practitioners should verify current fee schedule amounts, applicable regulatory frameworks, and recent appellate decisions addressing acupuncture billing disputes before relying on the legal standards discussed in this post.
