Key Takeaway
Court rules acupuncturists can bill for initial visits under code 99202, but leaves open question about reimbursement rates compared to chiropractors.
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.
Court Confirms Acupuncturists Can Bill for Initial Visits
A significant appellate ruling has clarified an important billing question for acupuncture providers working with no-fault insurance cases. The decision addresses whether acupuncturists can properly bill for initial evaluation visits and what this means for reimbursement rates under New York’s no-fault insurance system.
This case emerges from the complex landscape of medical billing codes and fee schedules that govern how healthcare providers are compensated for treating auto accident victims. The ruling specifically examined billing practices for acupuncture services, an area where providers have faced ongoing challenges regarding proper coding and reimbursement rates. Understanding these nuances is crucial for both providers seeking fair compensation and insurers managing claims costs.
Jason Tenenbaum’s Analysis:
Flushing Traditional Acupuncture, P.C. v Geico Ins. Co., 2013 NY Slip Op 51538(U)(App. Term 2d Dept. 2013)
The court has now explicitly held that a medical provider is entitled to bill for an initial acupuncture visit.
“the Civil Court properly granted the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover for those services. However, as defendant failed to address an “initial evaluation,” which had been billed under code 99202, defendant should not have been awarded summary judgment dismissing so much of the complaint as sought to recover the sum of $53.61 that was billed under that code.”
So the open question is whether an acupuncturist is entitled to the chiropractor rate for an initial visit and other rendered services?
I sense the answer is yes,
Key Takeaway
This ruling establishes that acupuncturists can properly bill for initial evaluation visits using code 99202, but leaves unresolved the critical question of reimbursement rates. The decision suggests that acupuncturists may be entitled to the same fee schedule rates as chiropractors, which could significantly impact billing practices and provider compensation in no-fault cases.
The implications extend beyond this specific case, as similar billing code questions arise with other treatment modalities covered under CPT codes like 97813 and 97814 for acupuncture services.
Legal Update (February 2026): Since this 2013 decision, New York’s no-fault fee schedules and billing codes have undergone multiple revisions, including updates to evaluation and management codes and acupuncture reimbursement rates. The regulatory framework governing initial visit billing and applicable fee schedules may have been substantially modified through Insurance Department amendments and statutory changes. Practitioners should verify current provisions in the most recent fee schedule regulations and consult updated billing guidelines before relying on the billing practices described in this post.
Related Articles
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
Keep Reading
More Fee Schedule Analysis
Acupuncture Reimbursements and Insurance Legalities Explained
Explore the Forrest Chen v. GEICO case and its impact on acupuncture insurance reimbursements in NY. Key insights for providers and patients.
Dec 11, 2024
Simple addition is insufficient
NY court rules simple addition insufficient to prove proper fee schedule calculations in no-fault insurance case, requiring detailed evidence of code utilization.
May 22, 2021
Reasonableness of healthcare bill
NY court case on healthcare provider's right to recover reasonable value for medical services when insurance claims are improperly processed or denied.
Mar 17, 2021
Court approves the chiro rate for Evaluation codes and consultation codes
Court approves chiropractor rates for evaluation and consultation codes in no-fault insurance case, upholding workers' compensation fee schedule reductions.
Nov 4, 2017
Coder’s affidavit is sufficient to prove non-conformity with the fee schedule
Court ruling establishes that certified professional coder's affidavit can prove proper fee schedule application, potentially impacting arbitration arguments about coder...
Aug 24, 2015
Surprised?
New York appellate court reverses lower court decision in Oriental World Acupuncture v GEICO, highlighting the importance of strategic appellate arguments in no-fault cases.
Jun 18, 2012Common Questions
Frequently Asked Questions
What is the no-fault fee schedule?
New York's no-fault fee schedule, established by the Workers' Compensation Board and the Department of Financial Services, sets the maximum reimbursement rates that no-fault insurers must pay for medical services. When an insurer pays less than the billed amount, citing the fee schedule as a defense, the provider can challenge the reduction by demonstrating that the fee schedule was improperly applied or that the services are not subject to fee schedule limitations.
Can a medical provider charge more than the fee schedule allows?
Medical providers treating no-fault patients are generally limited to the amounts set by the fee schedule and cannot balance-bill the patient for the difference. However, certain services may not be covered by the fee schedule, and disputes about whether a specific service falls within the fee schedule are common in no-fault litigation. The Department of Financial Services periodically updates the fee schedule rates.
How are fee schedule disputes resolved in no-fault arbitration?
When an insurer partially pays a claim citing the fee schedule, the provider can challenge the reduction through no-fault arbitration. The provider must demonstrate that the service billed is not subject to the fee schedule or that the fee schedule was incorrectly applied. The insurer bears the burden of proving the fee schedule applies and the correct rate was used. Fee schedule disputes often involve coding issues, modifier usage, and applicability of Workers' Compensation rates.
Does the no-fault fee schedule apply to all medical services?
Not all medical services are subject to the no-fault fee schedule. Certain services, supplies, and procedures may fall outside its scope, in which case the provider may bill the usual and customary rate. Disputes about whether a specific service or billing code is covered by the fee schedule are common. The Workers' Compensation Board fee schedule and the Department of Financial Services ground rules guide which services are covered and at what rates.
Was this article helpful?
About the Author
Jason Tenenbaum, Esq.
Jason Tenenbaum is the founding attorney of the Law Office of Jason Tenenbaum, P.C., headquartered at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746. With over 24 years of experience since founding the firm in 2002, Jason has written more than 1,000 appeals, handled over 100,000 no-fault insurance cases, and recovered over $100 million for clients across Long Island, Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
Jason is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts. His 2,353+ published legal articles analyzing New York case law, procedural developments, and litigation strategy make him one of the most prolific legal commentators in the state. He earned his Juris Doctor from Syracuse University College of Law.
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.
