Key Takeaway
Court decision analysis on acupuncture billing codes in NY no-fault insurance cases, examining fee schedule defenses and discovery requirements for CPT codes 97810 and 97811.
Charles Deng Acupuncture, P.C. v 21st Century Ins. Co., 2017 NY Slip Op 51252(U)(App. Term 2d Dept. 2017)
(1)”In this action by a provider to recover assigned first-party no-fault benefits, plaintiff appeals from an order of the Civil Court which denied plaintiff’s motion for summary judgment and granted the branches of defendant’s cross motion seeking summary judgment dismissing so much of the complaint as sought to recover upon claims for services billed under CPT codes 97810 and 97811, and to compel disclosure.”
(2) ” However, this court has held, “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”
(3) “Furthermore, plaintiff failed to object to the discovery demands at issue within the time prescribed by CPLR 3122 (a) and 3133 (a). Thus, plaintiff is obligated to produce the information sought by defendant except as to matters which are palpably improper or privileged”
I notice a trend with these decisions, where the Courts on the acupuncture cases are breaking down the cases “code by code”. It is a testament to the reality that acupuncture cases, except for the 810, 811, 813 and 814 involve frequently litigated issues where a bright line rule has not been set down.
It also interesting how what I perceive to intrusive discovery tends to be granted even though I suspect an offer of proof as to the issues upon which discovery is sought has not been set forth.
Related Articles
- NY acupuncture fee schedule limitations for licensed practitioners
- Understanding medical billing and down-coding practices
- Acupuncture prima facie defense and chiropractor rate limitations
- Fee schedule defense requirements and competent evidence standards
- New York No-Fault Insurance Law
Legal Update (February 2026): Since this 2017 post, New York’s no-fault fee schedules and reimbursement rates for acupuncture services may have been subject to regulatory amendments or updates. Additionally, procedural requirements under CPLR 3122 regarding discovery objections and the application of workers’ compensation fee schedules to acupuncture billing may have evolved through subsequent case law or regulatory changes. Practitioners should verify current fee schedule provisions and procedural requirements when handling acupuncture reimbursement matters.
