Key Takeaway
New York acupuncture fee schedule case analysis - chiropractor rate reductions, evaluation codes, and physical therapy billing issues in no-fault insurance claims.
Healthy Way Acupuncture P.C. v Metropolitan Prop. & Cas. Ins. Co., 2014 NY Slip Op 51127(U)(App. Term 1st Dept. 2014)
“Contrary to plaintiff’s assertion, the affidavit submitted by defendant’s claims representative, together with excerpts of the fee schedule of which we may take judicial notice (see Kingsbrook Jewish Med. Ctr. v Allstate Ins. Co., 61 AD3d 13, 21 ), were sufficient to establish defendant’s proper calculation of the fees due under the schedule (see Natural Acupuncture Health, P.C. v. Praetorian Ins. Co., 30 Misc 3d 132, 2011 NY Slip Op 500410 ; see also GL Acupuncture, P.C. v State Farm Mut. Auto. Ins. Co., 41 Misc 3d 131, 2013 NY Slip Op 51448 ).”
The real challenge with acupuncture fee schedule cases is not necessarily the reduction of the standard service codes to the chiropractor fee schedule rate. The problem involves the evaluation codes and physical therapy codes that are not properly reduced. While GL Acupuncture (my case – and if you read the record you would see that the initial visit was properly paid at the chiro rate) involved an initial service code paid at the chiropractic case, the newer issues involve the proper payments of other non-scheduled codes.
The consensus is to allow payment at the chiropractor rate for these services.
Related Articles
- NY Acupuncture Prima Facie Defense: Chiropractor Rate Limitations Upheld
- NY Acupuncture Fee Schedules: Licensed Practitioners Limited to Chiropractor Rates
- Fee Schedule Defense Requirements in No-Fault Insurance Cases
- Understanding competent evidence for fee schedule defenses
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2014 post, New York’s no-fault fee schedules and regulations governing acupuncture services may have been amended through regulatory updates or legislative changes. The fee schedule rates, coding requirements, and payment methodologies for acupuncture services, including evaluation and physical therapy codes, should be verified against current Insurance Department regulations and recent court decisions interpreting fee schedule applications.
