Key Takeaway
Okslen upheld a physician-schedule ceiling in 2014. Read the actual motion result, the missing similarity evidence, and the later service-date boundary.
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.
A physician rate can be a ceiling rather than a win for the provider. In Okslen Acupuncture v Travco (2014), the Appellate Term, First Department, affirmed dismissal of a claim seeking more than the physician acupuncture schedule allowed.
Legal Update (September 2026): DFS’s schedule guidance dates the later acupuncture schedule to services on or after October 1, 2020; Okslen’s physician-rate ceiling describes the earlier dispute, not today’s rate.
Last reviewed: September 2026
What the insurer proved
The insurer’s affidavits established mailing of the denial and the fee calculation. The provider’s attorney did not raise a factual dispute on either point. On the calculation, the attorney did not explain the nature of the treatment or show why it was not similar to acupuncture ordinarily performed by physicians under 11 NYCRR 68.5(b).
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That omission explains the result. The court did not approve a higher fee for specialized techniques, longer appointments or additional diagnostics. The reported opinion does not identify the treatment dates or bill amounts.
Reading the physician-rate language correctly
The opinion considered the physician schedule the insurer had used. It did not hold that every licensed acupuncturist could demand that rate, nor did it award the provider a difference between physician and chiropractic rates. Jason’s observation below asks what might happen on a better record. The actual claim was dismissed.
The later schedule adoption also limits the note’s present use. Match a disputed bill to its service date before applying an old comparison-rate decision.
Jason’s historical commentary
Jason’s 2014 observation follows. His suggested opening was an inference about a different record; Okslen itself upheld the physician-schedule ceiling. The statement about nobody succeeding has not been verified as a current fact:
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.
Connect to the Encyclopedia
Fee-schedule defense topic hub
- Raz: physician-rate payment and the initial-visit exception
- Sung Bok Lee: the older chiropractic-rate comparison
- Oriental World: the insurer won the appeal
- S.O.V.: code-specific limits on the dismissal
- LVOV: the coder affidavit and the provider’s response
For review of a particular bill or denial, contact the firm. The decision and commentary above concern the stated record; they do not determine a new claim.
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
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Mar 17, 2021Frequently Asked Questions
Common Questions About This Topic
4 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
Can acupuncturists be reimbursed at physician rates in New York no-fault cases?
In Okslen (2014), the insurer used the physician acupuncture schedule as a ceiling, and the court dismissed the claim for the excess. That was not a provider victory or a general entitlement to a higher rate.
What fee schedule applies to acupuncture under New York no-fault insurance?
The service date matters. DFS identifies October 1, 2020 as the effective date for the later acupuncture schedule. Okslen concerned the earlier comparison-rate framework and does not establish the amount payable for current treatment.
How can acupuncture providers challenge chiropractor rate limitations?
Okslen addressed a physician-schedule comparison, not a successful challenge to a chiropractic rate. The provider's attorney did not explain the nature of the services or show why they were not similar to physician acupuncture. The court did not approve particular techniques or longer sessions as exceptions.
What burden must insurers meet for fee schedule denials?
In Okslen, the insurer established mailing of the denial and the fee calculation; the provider did not raise a triable issue. That historical ruling should not be turned into an undated rule that every excess-fee defense is lost without a timely denial.
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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.
