Why Trust This Analysis
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.
This case from New York’s Appellate Term demonstrates a common pitfall in New York no-fault insurance law disputes: insurance companies focusing solely on routine treatment codes while overlooking initial evaluation charges. The ruling in Shara Acupuncture, P.C. v Allstate Ins. Co. shows how incomplete defense strategies can backfire, even when insurers successfully defend against the bulk of a provider’s claims.
The case involved an acupuncture provider seeking payment for services under multiple billing codes. While the insurance company successfully defended against charges for routine acupuncture treatments by demonstrating proper payment under the workers’ compensation fee schedule, they failed to address a separate initial evaluation code - a mistake that cost them summary judgment on that portion of the claim.
Jason Tenenbaum’s Analysis:
Shara Acupuncture, P.C. v Allstate Ins. Co., 2013 NY Slip Op 51731(U)(App. Term 2d Dept. 2013)
“With respect to plaintiff’s claims for acupuncture services billed under codes 97810 and 97811, defendant demonstrated that it had fully paid plaintiff for those services in accordance with the workers’ compensation fee schedule for acupuncture services performed by chiropractors (see Great Wall Acupuncture, P.C. v Geico Ins. Co., 26 Misc 3d 23 ). Accordingly, we do not disturb so much of the Civil Court’s order as, upon searching the record, awarded defendant summary judgment dismissing so much of the complaint as sought to recover for services billed under those codes. However, as defendant failed to address an “initial evaluation,” which had been billed under code 99203, defendant should not have been awarded summary judgment dismissing so much of the complaint as sought to recover the $75.11 that had been billed under that code.”
Free Consultation · No Fee Unless We Win
Does this apply to your situation?
Every case is different. Get a free, confidential case review from an experienced attorney who can tell you exactly where you stand.
That damned initial code again.
Key Takeaway
Insurance companies must comprehensively address all billing codes in their defense, not just the primary treatment codes. Even a successful defense of major claims can fail if initial evaluation or consultation codes are overlooked, allowing providers to recover on those specific charges despite losing on their main treatment billing disputes.
Legal Update (February 2026): Since this 2013 post was published, New York’s no-fault fee schedules and reimbursement rates have been subject to multiple regulatory amendments and updates. Practitioners should verify current fee schedule provisions, billing code requirements, and reimbursement methodologies, as the specific rates and procedures referenced in this case analysis may no longer reflect current law.
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
Judicial Notice has it outter limits
Court limits on judicial notice in no-fault insurance cases - workers' compensation fee schedule requires proper foundation and notice under CPLR 4511
Feb 20, 2017
Mr. SK Prime expanded Great Wall
SK Prime Med. Supply case marks first application of Great Wall precedent beyond acupuncture, establishing fee schedule standards for durable medical equipment in no-fault...
Apr 19, 2014
Chiropractor? fee schedule applied to acupuncture
Learn how chiropractor fee schedules affect acupuncture reimbursement under NY no-fault insurance.
Jan 20, 2011
April 2019 (add 18 months for no-fault): a new fee schedule
New April 2019 Workers Compensation fee schedule changes affecting NY no-fault insurance: chiropractic billing limits, eliminated ROM/MTT/PFT, reduced EMG costs, and PT rate...
Jan 15, 2019Was this article helpful?
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.
