Acupuncture fee schedule (again)

Integon won this appeal. The Appellate Term reversed the provider’s summary judgment and dismissed the complaint after finding proof of timely denials and full fee-schedule payment. The decision is useful evidence of a successful record—not a ruling that the carrier lost because it forgot to attach a schedule.

Legal Update (September 2026): This 2012 payment decision predates the October 1, 2020 adoption of the acupuncture schedule for no-fault services; its proof discussion belongs with the dated cases in the fee-schedule hub, not a current chiropractor-rate instruction.

Last reviewed: September 2026.

The result in MIA Acupuncture v Integon

MIA Acupuncture, P.C. v Integon General Insurance Corp., 2012 NY Slip Op 50393(U), was decided March 2, 2012, by the Appellate Term, Second Department. Kings County Civil Court had granted the provider’s motion for summary judgment and denied the insurer’s cross motion. The appellate court reversed both determinations.

Integon submitted an affidavit from its claims representative and another from an employee of the third party responsible for mailing its denials and partial payments. Taken together, the affidavits established timely denial of the disputed portion of the claims. The insurer also demonstrated full payment for the acupuncture services under the workers’ compensation fee schedule.

The provider therefore lost its judgment, and the insurer obtained dismissal. This is the opposite of using the case as an example of an insurer losing a motion for failing to submit fee-schedule evidence.

Two affidavits, two parts of the proof

The opinion identifies a claims representative and an employee of the mailing company. It does not say that every fee-schedule motion requires exactly two affidavits, or that a third-party witness is automatically sufficient. The significance lies in the facts those witnesses established on this record.

Mailing evidence addressed when the denials and payments were sent. Evidence of full scheduled payment addressed the amount remaining due. The existence of one kind of proof should not be mistaken for proof of the other. A timely denial can still rest on a mistaken calculation; an accurate calculation does not establish a mailing practice.

The archive’s Healing Art v Amica note makes a useful comparison. There, a claims representative established denial mailing while the fee-schedule vendor’s adjuster supported the payment determination. Neither decision says that outsourcing the calculation relieves a litigant of explaining it.

Jason’s original observation

Jason connected this successful motion with other acupuncture cases in which insurers had lost. His discussion of conversations with counsel is preserved as his 2012 commentary. Those conversations are not findings in the published Integon opinion.

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.

The short opinion does not inventory the insurer’s schedule exhibits or state that an express judicial-notice request was the decisive step. Jason’s observation helps explain why he selected the case; it should not be expanded into a holding the court did not write.

Judicial notice is not the payment calculation

The related Natural Acupuncture Health decision expressly discusses schedule excerpts and judicial notice when addressing Spring Medical’s claims. Integon instead gives a short account of the affidavits and the established payment. Reading the two decisions together is more useful than assigning either a universal exhibit checklist.

In Kingsbrook Jewish Medical Center v Allstate, 61 AD3d 13, the Appellate Division allowed judicial notice of an official diagnosis-and-procedure codes key but did not treat the decoded diagnoses as proof that the treatment was unrelated to the accident. The ability to consult an authoritative schedule does not identify, without evidence or explanation, which entries apply to a disputed bill.

For that reason, a court paper should distinguish the source of the governing rate from the factual calculation. The former identifies the rule; the latter connects it with the service, code, relevant period and payment. A request for judicial notice does not itself establish that every service was paid correctly.

This distinction also matters to the opposing party. An objection should identify the claimed gap: an incorrect schedule version, an unexplained code selection, a disputed payment or an unsupported witness assertion. The case does not establish that the mere absence of a document with a particular label defeats every motion.

Do not carry the old acupuncture rate into today’s bill

This note records a 2012 decision applying the older fee framework. The later 35th Amendment to Regulation 83 made the specified workers’ compensation schedule amendments applicable to no-fault services from October 1, 2020.

The statement that New York has no separate acupuncture schedule is therefore not an accurate current explanation. A current claim needs the schedule and ground rules applicable to its service date and provider type. The historical use of a chiropractor schedule in the cited cases is not proof that a particular provider’s treatment was performed by a chiropractor.

Dates also matter to denial preclusion. Integon’s proof included timely denial. The Saddle Brook amendment note addresses a different issue: the post-April 1, 2013 treatment of an excessive-fee defense even when the denial was late. Neither note should silently substitute its timing analysis for the other.

A useful comparison for the reader

If the question is whether the insurer proved full scheduled payment, start with Integon and Healing Art. If the objection concerns what a court may judicially notice, follow the schedule-source discussion in Natural Acupuncture Health and Kingsbrook. If one billed code was never addressed, the Shara initial-evaluation decision shows why an otherwise successful fee defense may leave a separate claim unresolved.

Those distinctions explain why several acupuncture posts remain separate in the library. They are not repeated answers to one reimbursement question. They document different records, different objections and, in Shara, a different result for different portions of the same bill.

For an actual disputed payment, collect the dated bill, schedule explanation, payment record and denial before drawing a conclusion from the case title. The published Integon decision supports dismissal on the proof it describes. It does not provide a current fee table, prescribe a universal affidavit form or promise that the same outcome follows from a similar-sounding objection.

Connect to the Encyclopedia

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

• Healing Art: claims-representative and vendor proof had separate jobs.
• Natural Acupuncture Health: schedule excerpts and judicial notice.
• Shara: an unaddressed initial-evaluation code remained in the case.
• Saddle Brook: the later excessive-fee amendment changed preclusion.
• Precious Acupuncture: full payment established by a certified coder.

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.