Key Takeaway
Healing Art v Progressive: the 2019 trial proof concerning acupuncture codes 97810 and 97811, and why its older rate ruling needs a service date.
This article is part of our ongoing fee schedule coverage, with 388 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.
The decisive feature in Healing Art Acupuncture v Progressive, 2019 NY Slip Op 50574(U) was the agreed trial record. On April 12, 2019, the Appellate Term, Second Department, affirmed judgment for the insurer on acupuncture bills coded 97810 and 97811.
Historical note: Healing Art upheld a calculation under the older chiropractor-schedule framework; DFS identifies the later acupuncture schedule adoption and service-date rules, which must be checked before applying that historical rate to newer treatment.
Last reviewed: September 2026.
How the coding proof reached this trial
The parties stipulated to the provider’s prima facie case, timely denial and the witness’s medical-coding credentials. The court took judicial notice of the chiropractor fee schedule. In the companion GL Acupuncture trial, the witness gave credible, unrebutted testimony supporting the payment calculation. Counsel agreed that the witness would testify the same way in Healing Art.
Free Consultation · No Fee Unless We Win
Does this apply to your situation?
Every case is different. Get a free, confidential case review from an experienced attorney who can tell you exactly where you stand.
That agreement explains the result. The opinion did not excuse evidentiary support merely because someone held a coding credential. Nor did it decide that acupuncture was medically unnecessary or that a provider must disprove every reduction before the insurer supports its own position.
Keep the codes and the schedule separate
The CMS descriptions identify 97810 as an initial non-electrical acupuncture interval and 97811 as an additional interval with needle reinsertion. That code distinction does not set New York’s payment amount; Medicare reimbursement rules are not used here.
The later Live In Grace appeal concerned the electrical-stimulation pair, 97813 and 97814. Reading the cases together is more useful than treating “acupuncture” as a single undifferentiated billing code.
Connect to the Encyclopedia
Start with the fee-schedule defense hub. Related case notes:
- Urban Well: coding corrections and separate necessity proof.
- OS Tigris: an unsupported fee-schedule defense.
- Great Wall: the November 2009 trial record.
- Great Wall: the split result in the August 2009 appeal.
- Live In Grace: the electrical-stimulation codes 97813 and 97814.
- Precious Acupuncture: coder proof and post-2013 preclusion.
- Quality Comprehensive: fee proof supported only partial dismissal.
- Acuhealth: the missing by-report verification request.
For review of a particular no-fault billing dispute, contact the Law Office of Jason Tenenbaum. Bring the bill, service dates, denial and payment calculation.
Legal Context
Why This Matters for Your Case
New York's no-fault insurance system, established under Insurance Law Article 51, is one of the most complex insurance frameworks in the country. Every motorist must carry Personal Injury Protection coverage that pays medical expenses and lost wages regardless of fault, up to $50,000 per person.
But insurers routinely deny valid claims using peer reviews, EUO scheduling tactics, fee schedule reductions, and coverage defenses. The Law Office of Jason Tenenbaum has handled over 100,000 no-fault cases since 2002 — from initial claim submissions through arbitration before the American Arbitration Association, trials in Civil Court and Supreme Court, and appeals to the Appellate Term and Appellate Division. Jason Tenenbaum is one of the few attorneys in the state who both writes his own appellate briefs and tries his own cases.
His 2,353+ published legal articles on no-fault practice are cited by attorneys throughout New York. Whether you are dealing with a medical necessity denial, an EUO no-show defense, a fee schedule dispute, or a coverage question, this article provides the kind of detailed case-law analysis that helps practitioners and claimants understand exactly where the law stands.
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.
388 published articles in Fee Schedule
Keep Reading
More Fee Schedule Analysis
Car Accident Recorded Statement in New York: Should You Give One?
The at-fault driver's adjuster wants a recorded statement within days of a New York car accident — and that call is designed to weaken your case.
Apr 5, 2026
Who Pays Car Accident Medical Bills in New York? A Step-by-Step Guide
New York no-fault PIP, primary health insurance, Medicaid/Medicare, and litigation liens — the full payment ladder for car-accident medical bills.
Apr 5, 2026
Manual muscle testing from the 4th DCA
4th DCA ruling on manual muscle testing CPT codes in no-fault insurance - provider failed to justify unbundling evaluation codes with required documentation
Jun 24, 2021
Wrong subdivision in traffic ticket still actionable
Traffic ticket errors don't automatically lead to dismissal.
Jun 10, 2017
I wonder which plaintiff no-fault firm wrote this and had this State Senator introduce it…
Analysis of proposed New York no-fault insurance law changes affecting examination under oath procedures and claimant rights in 2012.
Jun 21, 2012
Is Your NY Insurer Acting in Bad Faith?
Learn how insurers commit bad faith under NY's No-Fault Law and how to fight denied claims with legal strategies.
Feb 25, 2025Frequently Asked Questions
Common Questions About This Topic
5 answers from the firm's New York personal-injury and employment-law practice. Click any question to expand.
Q: What happens if my acupuncture treatment is denied by no-fault insurance?
Identify whether the dispute concerns coverage, medical necessity, code selection or the fee calculation. Healing Art decided a payment dispute on a stipulated trial record, not every kind of treatment denial.
Q: Can insurance companies use different fee schedules for acupuncture services?
The older decisions allowed the chiropractor schedule in the circumstances they addressed. Later acupuncture schedule adoption means the service date and provider type must be checked before selecting a schedule.
Q: How important is proper documentation for acupuncture billing?
The billed services and calculation need support. In this case the court relied on admitted schedule material and agreed coder testimony, not a general claim that documentation was adequate.
Q: What role do certified medical coders play in insurance disputes?
The credential was stipulated here, but the court also relied on the substance of the witness's testimony. Certification alone is not a substitute for explaining the challenged payment.
Q: Are there time limits for appealing insurance denials of acupuncture treatment?
Act promptly to identify the available procedure and its deadline with counsel. This opinion does not set a single appeal period covering every court, arbitration and claim situation.
Was this article helpful?
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.
