Acupuncture paid at physician rate sustained on appeal

Okslen Acupuncture P.C. v Travco Ins. Co., 2014 NY Slip Op 51209(U)(App. Term 1st Dept. 2014):

“The affidavits submitted by defendant in support of its motion for summary judgment established prima facie that defendant timely and properly denied plaintiff’s no-fault claim to the extent plaintiff sought reimbursement in an amount greater than that authorized by the workers’ compensation fee schedule applicable to physicians who render acupuncture services (see Akita Med. Acupuncture, P.C. v Clarendon Ins. Co., 41 Misc 3d 134, 2013 NY Slip Op 51860; Great Wall Acupuncture v Geico Gen. Ins. Co., 16 Misc 3d 23 ). In opposition, plaintiff failed to raise a triable issue as to the efficacy of defendant’s mailing of the claim denial or the calculation of the fee. With respect to the latter, the affirmation submitted by plaintiff’s counsel did not address the nature of the acupuncture services rendered to plaintiff’s assignor, much less demonstrate that those services were not “similar” to acupuncture services generally provided by physicians, so as to exempt plaintiff from the reach of the physicians’ workers’ compensation fee schedule”

What is interesting is that this is now the second time this Court has left the door open for a medical provider – on a proper record – to obtain a fee for acupuncture in excess of that established in the chiropractor fee schedule.  Nobody ha succeeded as of yet.

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
• Understanding Medical Billing and Down-Coding in New York No-Fault Insurance Claims
• New York No-Fault Insurance Law

Legal Update (February 2026): Since this 2014 decision, New York’s no-fault fee schedules and workers’ compensation fee schedules referenced in acupuncture reimbursement cases may have been subject to regulatory amendments or rate adjustments. Practitioners should verify current fee schedule provisions and any updated regulations governing acupuncture services reimbursement under no-fault insurance, as both the underlying fee structures and procedural requirements for challenging reimbursement denials may have evolved.