Key Takeaway
Live In Grace v GEICO: the appeal over acupuncture codes 97813 and 97814, the fee-schedule proof and the limits of Jason's historical shorthand.
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.
CPT 97813 and 97814 concern acupuncture with electrical stimulation, not the non-electrical pair 97810 and 97811. The distinction matters when reading Live In Grace Acupuncture v GEICO, 2020 NY Slip Op 51360(U), decided November 13, 2020.
Historical note: Live In Grace upheld the calculation on the appealed claims; DFS explains the October 2020 no-fault schedule changes by service date, so Jason’s “CHIRO rate” shorthand is not a current pricing instruction.
Last reviewed: September 2026.
What was actually on appeal
The insurer established full payment under the applicable workers’ compensation fee schedule for the disputed services billed under 97813 and 97814. The Appellate Term, Second Department, upheld dismissal of those appealed claims and the denial of the provider’s motion concerning one assignor. The opinion should not be described as adjudicating every acupuncture bill in the action.
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The services were rendered after April 1, 2013, so the court applied the excessive-fee nonpreclusion rule. That date concerns preservation of this defense; it was not when New York first began using workers’ compensation schedules in no-fault reimbursement.
Code identity is not a payment calculation
The CMS code descriptions distinguish an initial electrical-stimulation acupuncture interval, 97813, from an additional interval with needle reinsertion, 97814. They are cited here to identify the codes, not to import Medicare coverage limits or payment rules into New York no-fault.
A November 2020 decision date does not establish that treatment occurred after the October 2020 schedule change. Read the service dates before applying this historical rate holding to a later bill. The archive’s Healing Art note concerns the different 97810/97811 pair.
Jason’s original shorthand
Jason’s brief original reaction referred to the schedule used in this appeal, not an exception-free rule for future services:
CHIRO rate.
Connect to the Encyclopedia
Start with the fee-schedule defense hub. Related case notes:
- Urban Well: coding corrections and separate necessity proof.
- Great Wall: the November 2009 trial record.
- Great Wall: the split result in the August 2009 appeal.
- Healing Art: agreed coder testimony on codes 97810 and 97811.
- New Age: the denied motion on CPT 97026.
- Precious Acupuncture: coder proof and post-2013 preclusion.
- 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 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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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.
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