Key Takeaway
First Department ruling on acupuncture fee schedule disputes in no-fault cases, highlighting importance of proper billing rates and timely denial procedures.
The intersection of acupuncture services and New York’s no-fault insurance system continues to generate litigation, particularly around proper billing rates and fee schedules. This case from the First Department’s Appellate Term illustrates common challenges healthcare providers face when billing for acupuncture treatments under New York No-Fault Insurance Law.
Acupuncture billing in no-fault cases often involves complex questions about which fee schedule applies - whether providers should bill at chiropractic rates or physician rates can significantly impact reimbursement amounts. The 120-day rule and Fee Schedule requirements add another layer of complexity for both providers and insurers navigating these claims.
Jason Tenenbaum’s Analysis:
Lotus Acupuncture, P.C. v MVAIC, 2013 NY Slip Op 51925(U)(App. Term 1st Dept. 2013)
“The affidavits submitted by defendant in support of its motion for summary judgment established that defendant timely denied (see St. Vincent’s Hosp. of Richmond v Government Empls. Ins. Co., 50 AD3d 1123 ) plaintiff’s claim for assigned first-party no-fault benefits on the ground that the fees plaintiff charged for the acupuncture services it rendered to the assignor exceeded the amount permitted by the worker’s compensation fee schedule. In opposition, plaintiff failed to raise a triable issue as to the efficacy of defendant’s mailing of the denial or the calculation of the fee. Therefore, defendant’s motion for summary judgment dismissing the claim – which sought the difference between the amount charged for the services and payments made to plaintiff pursuant to the fee schedule – should have been granted.”
This case does not seem to stand for much since we do not know if MVAIC paid the chiro or physician rate for the acupuncture services at issue.
Key Takeaway
This decision reinforces that insurers can successfully defend against acupuncture fee disputes by demonstrating timely denial and proper fee schedule application. However, the ruling’s limited precedential value stems from the lack of clarity about which specific billing rate was applied to the acupuncture services in question.
Legal Update (February 2026): Since this 2013 post, New York’s no-fault fee schedules and acupuncture billing regulations may have been substantially revised through regulatory amendments or Department of Financial Services updates. Practitioners should verify current fee schedule provisions, billing code requirements, and reimbursement rates for acupuncture services, as the referenced worker’s compensation fee schedule standards and applicable billing methodologies may no longer reflect current law.
