Key Takeaway
First Department ruling on acupuncture fee schedules in no-fault insurance cases, analyzing chiropractor rate limitations and prima facie defense requirements.
Akita Med. Acupuncture, P.C. v Clarendon Ins. Co., 2013 NY Slip Op 51860(U)(App. Term 1st Dept. 2013)
“The complaint seeks the difference between the amount billed by plaintiff, $120 per session, and the amount paid by the defendant-insurer, $29.30 per session.” (This looks like an old 97780 case)
Defendant’s prima facie entitlement to summary judgment
“; see Forrest Chen Acupuncture Servs, P.C. v Geico Ins. Co., 54 AD3d 996, 997 ), specifically, 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 ; Ops. Gen. Counsel NY Ins. Dept. No. 04—10—03 ).”
Plaintiff failed to raise an issue of fact
“Nor did plaintiff establish or raise a triable issue that the acupuncture work sued for did not constitute a “similar procedure” than the one defendant chose for comparison in arriving at the reimbursement rate.”
Note how the Appellate Term Second Department resolved the issues: “Accordingly, in light of the licensure requirements, we hold, as a matter of law, that an insurer may use the workers’ compensation fee schedule for acupuncture services performed by chiropractors to determine the amount which a licensed acupuncturist is entitled to receive for such acupuncture services”. Yet, the Court is still allowing Plaintiff’s to present proof to vault Great Wall II. Interesting.
Related Articles
- NY Acupuncture Fee Schedules: Licensed Practitioners Limited to Chiropractor Rates
- NY Acupuncture Prima Facie Defense: Chiropractor Rate Limitations Upheld
- Fee Schedule Defense Requirements in No-Fault Insurance Cases
- Fee schedule defense – competent evidence?
- New York No-Fault Insurance Law
Legal Update (February 2026): The fee schedules and reimbursement methodologies for acupuncture services under New York’s no-fault insurance system have been subject to regulatory amendments and updates since this 2013 decision. Additionally, the Department of Financial Services has issued updated guidance on fee schedule applications and the use of workers’ compensation schedules for comparison purposes. Practitioners should verify current fee schedule provisions and recent regulatory interpretations when evaluating acupuncture reimbursement disputes.
