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This article is part of our ongoing fee schedule coverage, with 118 published articles analyzing fee schedule issues across New York State. Attorney Jason Tenenbaum brings 24+ years of hands-on experience to this analysis, drawing from his work on more than 1,000 appeals, over 100,000 no-fault cases, and recovery of over $100 million for clients throughout Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, and the Bronx. For personalized legal advice about how these principles apply to your specific situation, contact our Long Island office at (516) 750-0595 for a free consultation.
New York’s no-fault insurance system requires insurers to promptly pay for medically necessary treatment, including acupuncture services. However, insurance companies frequently attempt to avoid payment by challenging various aspects of healthcare provider claims. One common tactic involves filing motions to dismiss claims for initial acupuncture sessions, often arguing that proper documentation wasn’t provided or that fees exceed allowable rates under the workers’ compensation fee schedule.
The workers’ compensation fee schedule serves as the payment standard for many no-fault treatments, including acupuncture services covered under CPT codes 97813 and 97814. When insurers challenge these claims, they must provide substantial evidence to support dismissal. This case demonstrates the courts’ scrutiny of such challenges, particularly when insurers fail to adequately prove their contentions about excessive billing or insufficient documentation.
Understanding the relationship between no-fault insurance law and fee schedule requirements is crucial for both providers and patients navigating these disputes.
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Perfect Point Acupuncture, P.C. v Clarendon Ins. Co., 2012 NY Slip Op 50399(U)(App. Term 2d Dept. 2012)
“That affidavit, however, was sufficient neither to warrant the dismissal of plaintiff’s claim for the initial acupuncture visit of April 18, 2006 (see Raz Acupuncture, P.C. v AIG Indem. Ins. Co., 28 Misc 3d 127, 2010 NY Slip Op 51177 ) nor to establish defendant’s contention that the amounts that had been charged by plaintiff for the acupuncture services rendered exceeded the relevant rates set forth in the workers’ compensation fee schedule”
Key Takeaway
The Appellate Term’s decision reinforces that insurance companies cannot simply file affidavits making broad assertions to dismiss acupuncture claims. They must provide concrete evidence showing either inadequate documentation or excessive billing compared to fee schedule requirements. This ruling protects healthcare providers’ rights to payment for legitimate initial acupuncture sessions and sets a higher standard for insurer dismissal motions.
Legal Update (February 2026): Since this post’s publication in 2012, New York’s no-fault fee schedules and reimbursement rates have undergone multiple revisions, including updates to workers’ compensation fee schedules that serve as payment standards for acupuncture services. Additionally, regulatory changes may have affected documentation requirements and claim processing procedures for initial acupuncture sessions. Practitioners should verify current fee schedule provisions and procedural requirements, as rates and documentation standards have likely been modified over the intervening years.
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Legal Context
Why This Matters for Your Case
New York law is among the most complex and nuanced in the country, with distinct procedural rules, substantive doctrines, and court systems that differ significantly from other jurisdictions. The Civil Practice Law and Rules (CPLR) governs every stage of civil litigation, from service of process through trial and appeal. The Appellate Division, Appellate Term, and Court of Appeals create a rich and ever-evolving body of case law that practitioners must follow.
Attorney Jason Tenenbaum has practiced across these areas for over 24 years, writing more than 1,000 appellate briefs and publishing over 2,353 legal articles that attorneys and clients rely on for guidance. The analysis in this article reflects real courtroom experience — from motion practice in Civil Court and Supreme Court to oral arguments before the Appellate Division — and a deep understanding of how New York courts actually apply the law in practice.
About This Topic
Fee Schedule Issues in No-Fault Insurance
The New York no-fault fee schedule establishes the maximum reimbursement rates for medical treatment provided to injured motorists. Disputes over fee schedule calculations, coding, usual and customary charges, and the applicability of workers compensation fee schedules to no-fault claims are common. These articles analyze fee schedule regulations, court decisions on reimbursement disputes, and the practical challenges providers face in obtaining appropriate payment under the no-fault system.
118 published articles in Fee Schedule
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Disclaimer: This article is published by the Law Office of Jason Tenenbaum, P.C. for informational and educational purposes only. It does not constitute legal advice, and no attorney-client relationship is formed by reading this content. The legal principles discussed may not apply to your specific situation, and the law may have changed since this article was last updated.
New York law varies by jurisdiction — court decisions in one Appellate Division department may not be followed in another, and local court rules in Nassau County Supreme Court differ from those in Suffolk County Supreme Court, Kings County Civil Court, or Queens County Supreme Court. The Appellate Division, Second Department (which covers Long Island, Brooklyn, Queens, and Staten Island) and the Appellate Term (which hears appeals from lower courts) each have distinct procedural requirements and precedents that affect litigation strategy.
If you need legal help with a fee schedule matter, contact our office at (516) 750-0595 for a free consultation. We serve clients throughout Long Island (Huntington, Babylon, Islip, Brookhaven, Smithtown, Riverhead, Southampton, East Hampton), Nassau County (Hempstead, Garden City, Mineola, Great Neck, Manhasset, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, Massapequa), Suffolk County (Hauppauge, Deer Park, Bay Shore, Central Islip, Patchogue, Brentwood), Queens, Brooklyn, Manhattan, the Bronx, Staten Island, and Westchester County. Prior results do not guarantee a similar outcome.
