Simple addition is insufficient
NY court rules simple addition insufficient to prove proper fee schedule calculations in no-fault insurance case, requiring detailed evidence of code utilization.
Simple addition is insufficient — Read Article → 118 Articles
Fee Schedule
In-depth legal analysis from Attorney Jason Tenenbaum — covering court rulings, legal standards, and practical guidance on fee schedule under New York law.
Expert Analysis
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.
Read Our Fee Schedule Articles
Frequently Asked Questions
Common Questions About Fee Schedule
What is the no-fault fee schedule?
New York's no-fault fee schedule, established by the Workers' Compensation Board and the Department of Financial Services, sets the maximum reimbursement rates that no-fault insurers must pay for medical services. When an insurer pays less than the billed amount, citing the fee schedule as a defense, the provider can challenge the reduction by demonstrating that the fee schedule was improperly applied or that the services are not subject to fee schedule limitations.
Can a medical provider charge more than the fee schedule allows?
Medical providers treating no-fault patients are generally limited to the amounts set by the fee schedule and cannot balance-bill the patient for the difference. However, certain services may not be covered by the fee schedule, and disputes about whether a specific service falls within the fee schedule are common in no-fault litigation. The Department of Financial Services periodically updates the fee schedule rates.
How are fee schedule disputes resolved in no-fault arbitration?
When an insurer partially pays a claim citing the fee schedule, the provider can challenge the reduction through no-fault arbitration. The provider must demonstrate that the service billed is not subject to the fee schedule or that the fee schedule was incorrectly applied. The insurer bears the burden of proving the fee schedule applies and the correct rate was used. Fee schedule disputes often involve coding issues, modifier usage, and applicability of Workers' Compensation rates.
Does the no-fault fee schedule apply to all medical services?
Not all medical services are subject to the no-fault fee schedule. Certain services, supplies, and procedures may fall outside its scope, in which case the provider may bill the usual and customary rate. Disputes about whether a specific service or billing code is covered by the fee schedule are common. The Workers' Compensation Board fee schedule and the Department of Financial Services ground rules guide which services are covered and at what rates.
Reasonableness of healthcare bill
NY court case on healthcare provider's right to recover reasonable value for medical services when insurance claims are improperly processed or denied.
Reasonableness of healthcare bill — Read Article →
PT Fee schedule denial not substantiated
New York court ruling highlights insurance carriers must properly authenticate documents when denying physical therapy claims under fee schedule limits.
PT Fee schedule denial not substantiated — Read Article →
The power of the certified medical coder
Court ruling demonstrates how certified medical coders can establish proper fee schedule application in New York no-fault insurance disputes through expert affidavits.
The power of the certified medical coder — Read Article →
CPT Code 97813 and 97814
New York court ruling clarifies CPT codes 97813 and 97814 acupuncture billing rates under workers' compensation fee schedule for no-fault insurance claims.
CPT Code 97813 and 97814 — Read Article →Need Legal Guidance?
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The chiropractor rate
Court upholds chiropractor fee schedule rates for acupuncture services in NY no-fault insurance case, limiting reimbursement despite provider credentials.
The chiropractor rate — Read Article →
120-day rule and Fee Schedule
New York court ruling demonstrates how healthcare providers can lose no-fault claims due to verification failures and fee schedule violations in insurance disputes.
120-day rule and Fee Schedule — Read Article →
Verification and fee schedule issues
Analysis of Blackman v Nationwide Ins. case addressing verification affidavit mailing presumptions and fee schedule defense preservation requirements in NY no-fault law.
Verification and fee schedule issues — Read Article →
Fee schedule is not precluded/ New Jersey FS discussion
Learn NY-NJ cross-border medical billing & fee schedules. Expert analysis of Excel Surgery decision & out-of-state treatment. Call 516-750-0595.
Fee schedule is not precluded/ New Jersey FS discussion — Read Article →
Certified Professional Coder
Learn how certified medical coders impact workers comp billing disputes in NY. Expert legal analysis of fee schedules & coding. Call 516-750-0595.
Certified Professional Coder — Read Article →
New York No-Fault By Report Billing: Insurance Carrier Verification Requirements Explained
Learn how NY No-Fault by report billing works and insurance carrier verification requirements. Expert analysis of Bronx Acupuncture case. Call 516-750-0595.
New York No-Fault By Report Billing: Insurance Carrier Verification Requirements Explained — Read Article →
The CPT code book and CPT Assistant are admissible as a matter of course
Court rules CPT code book and CPT Assistant are admissible in NY no-fault insurance fee disputes, reversing arbitrator's exclusion of coding guidance materials.
The CPT code book and CPT Assistant are admissible as a matter of course — Read Article →
Understanding Acupuncture Billing Codes in New York No-Fault Insurance Claims | Long Island Personal Injury Lawyer
Expert analysis of NY acupuncture billing codes & no-fault insurance disputes. Learn your rights when insurance denies treatment. Call 516-750-0595 for help.
Understanding Acupuncture Billing Codes in New York No-Fault Insurance Claims | Long Island Personal Injury Lawyer — Read Article →
April 2019 (add 18 months for no-fault): a new fee schedule
New April 2019 Workers Compensation fee schedule changes affecting NY no-fault insurance: chiropractic billing limits, eliminated ROM/MTT/PFT, reduced EMG costs, and PT rate...
April 2019 (add 18 months for no-fault): a new fee schedule — Read Article →
Understanding Medical Billing and Down-Coding in New York No-Fault Insurance Claims
Insurance companies reduce medical bills through down-coding. Learn your rights when CPT codes are changed and how to challenge improper billing decisions. Call 516-750-0595
Understanding Medical Billing and Down-Coding in New York No-Fault Insurance Claims — Read Article →
The By Report paradigm
Analysis of Pavlova v Allstate case on "by report" billing requirements and verification procedures in NY no-fault insurance claims (156 chars)
The By Report paradigm — Read Article →
A 65-3.2 sighting
Village Medical Supply case shows insurance carriers can use 11 NYCRR 65-3.2(c) to defend verification requests, marking a shift in no-fault insurance litigation strategy.
A 65-3.2 sighting — Read Article →
More Acupuncture fee Schedule – no new ground covered here
NY court upholds workers' compensation fee schedule for acupuncture services and rejects fee schedule defense preclusion in 2018 no-fault insurance case.
More Acupuncture fee Schedule – no new ground covered here — Read Article →
CPM – now it is up to DFS and WCB to address the problem
Appellate Division rules CPM reimbursement must be at general public rental value. Analysis of 6-year no-fault insurance billing dispute and DFS/WCB regulatory gaps.
CPM – now it is up to DFS and WCB to address the problem — Read Article →
+15 minute decision begs a better question
Court ruling on acupuncture needle reinsertion claims raises questions about partial false billing defenses in NY no-fault insurance cases.
+15 minute decision begs a better question — Read Article →
8 units may apply to various specialties
NY Workers' Compensation Board clarifies 8 RVU limitation rules for physical therapy and chiropractic treatment in no-fault insurance claims.
8 units may apply to various specialties — Read Article →
8 units per diem – the Workers Compensation Board has spoken
Workers Compensation Board clarifies 8-unit daily limit rule for PT treatments in NY no-fault insurance cases - CMT codes don't count toward non-chiro limits.
8 units per diem – the Workers Compensation Board has spoken — Read Article →
Fee Schedule/not precluded
Analysis of Oleg's Acupuncture v Hereford Insurance case examining fee schedule defenses, untimely denials, and certified medical coder affidavits in NY no-fault claims.
Fee Schedule/not precluded — Read Article →
Certified medical coder sufficient
Court ruling establishes that a certified medical coder's affidavit provides sufficient evidence to support workers' compensation fee schedule defenses in summary judgment motions.
Certified medical coder sufficient — Read Article →
CPM from the Civil Court
Civil Court ruling supports CPM reimbursement claims by medical providers, creating significant implications for no-fault insurance reimbursement rates and regulatory oversight.
CPM from the Civil Court — Read Article →
By report? Again?
Analysis of BR code requirements in New York no-fault insurance fee schedule disputes, examining provider prima facie cases and affirmative defenses.
By report? Again? — Read Article →
Fee schedule defense not substantiated
NY court rules insurance company failed to substantiate fee schedule defense by not proving correct conversion factor was used in calculating reimbursement rates.
Fee schedule defense not substantiated — Read Article →
CPT Code 97039 again
Court ruling on CPT Code 97039 billing disputes in NY no-fault insurance cases, covering "By Report" documentation requirements and insurer denial defenses.
CPT Code 97039 again — Read Article →
Fee schedule defense failed
Court ruling in Laga v GEICO shows insurers must provide precise proof when applying Ground Rule 11 reductions to no-fault medical bills under New York's fee schedule.
Fee schedule defense failed — Read Article →
Court approves the chiro rate for Evaluation codes and consultation codes
Court approves chiropractor rates for evaluation and consultation codes in no-fault insurance case, upholding workers' compensation fee schedule reductions.
Court approves the chiro rate for Evaluation codes and consultation codes — Read Article →
By-Report
Court rules insurers must request additional documentation for "By Report" CPT codes before denying no-fault claims, addressing proper claim procedures.
By-Report — Read Article →
A new 68.6 is coming next year
New Jersey implements crucial no-fault insurance fee schedule regulation 68.6 in 2018, addressing long-standing billing inconsistencies and overbilling practices.
A new 68.6 is coming next year — Read Article →
Repriced CPT Code 64550
Court upholds insurance carrier's repricing of CPT code 64550 to 97014 in no-fault case, demonstrating proper application of workers' compensation fee schedule.
Repriced CPT Code 64550 — Read Article →
Acupuncture that is broken down by code
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.
Acupuncture that is broken down by code — Read Article →
CPT Code 970309
Court rejects insurer's "out of scope" defense for CPT code 97039, finding triable issues regarding proper denial of no-fault acupuncture claim.
CPT Code 970309 — Read Article →
No acupuncture fee schedule estoppel
NY court confirms acupuncturists are limited to chiropractor fee schedule rates regardless of prior payments at higher medical doctor rates in no-fault insurance claims.
No acupuncture fee schedule estoppel — Read Article →
C.f. 20553
Court upholds insurer's application of workers' compensation fee schedule to CPT code 20553, highlighting ongoing disputes over proper billing methodologies in no-fault cases.
C.f. 20553 — Read Article →
Functional ATIC/ medial necessity and fee schedule defense susbstantiated
New York court decision on medical necessity and fee schedule defenses in no-fault insurance cases, featuring expert affidavit requirements and proper coding analysis.
Functional ATIC/ medial necessity and fee schedule defense susbstantiated — Read Article →
Back when ATIC had a functional litigation defense strategy
ATIC's functional litigation defense strategy in Compas Med v American Trust Insurance Co case involving fee schedule defenses and CPT code bundling issues.
Back when ATIC had a functional litigation defense strategy — Read Article →
Hearsay insufficient to substantiate a fraud defense/Fee Schedule discussion
Court ruling on hearsay evidence in no-fault insurance fraud defenses and fee schedule denial requirements. Analysis of Box #18 denials and coverage disputes.
Hearsay insufficient to substantiate a fraud defense/Fee Schedule discussion — Read Article →
Substantive fee schedule discussion/Procedural analysis
Analysis of Gentle Acupuncture v Tri-State Consumer Insurance case examining fee schedule defenses and affidavit requirements in New York no-fault claims.
Substantive fee schedule discussion/Procedural analysis — Read Article →
Non acupuncture based add on codes – issue of fact
Court rules insurance company failed to prove proper denial of non-acupuncture CPT codes 97026 and 97016 under workers' compensation fee schedule requirements.
Non acupuncture based add on codes – issue of fact — Read Article →
The Maslow specificity rule went up in a plume of smoke
Court ruling on fee schedule defense preservation in NY no-fault insurance claims, addressing the eight unit rule and arbitrator award reversal.
The Maslow specificity rule went up in a plume of smoke — Read Article →
A true prima facie showing on summary judgment motion
Appellate Term ruling demonstrates how no-fault insurers lose defenses when they fail to timely deny claims, particularly for acupuncture services under New York's fee schedule.
A true prima facie showing on summary judgment motion — Read Article →
Judicial Notice has it outter limits
Court limits on judicial notice in no-fault insurance cases - workers' compensation fee schedule requires proper foundation and notice under CPLR 4511
Judicial Notice has it outter limits — Read Article →
The By-Report
Analysis of Bronx Acupuncture v Hereford case clarifying that by-report codes are verification issues, not automatic denials in NY no-fault insurance claims.
The By-Report — Read Article →
Policy exhaustion and fee schedule concerns
Easy Care Acupuncture v MVAIC case explores policy exhaustion defenses and fee schedule reductions in New York no-fault insurance acupuncture claims disputes.
Policy exhaustion and fee schedule concerns — Read Article →
Claims representative’s attestation is sufficient to make a prima facie showing
Court ruling establishes that a claims representative's affidavit explaining fee calculations using relative values and conversion factors creates sufficient prima facie evidence.
Claims representative’s attestation is sufficient to make a prima facie showing — Read Article →
Fee Schedule and 8 unit issue
Liberty Chiropractic v 21st Century Insurance case examining fee schedule defenses and 8-unit limitations under NY no-fault law, authentication requirements.
Fee Schedule and 8 unit issue — Read Article →
The DME equivalent of Robert Physical Therapy plays out
New York court rules that DME not included in fee schedules can still be compensable under 11 NYCRR 68.5, overturning insurance carrier arguments.
The DME equivalent of Robert Physical Therapy plays out — Read Article →
Amendment of 11 NYCRR 68.6 coming soon
New York proposes amending 11 NYCRR 68.6 to limit out-of-state no-fault health service reimbursement to highest NYS fee schedule rates for 2016.
Amendment of 11 NYCRR 68.6 coming soon — Read Article →
A sighting of “interboard” in action
Court ruling shows "interboard" IME cutoff requirements in action - acupuncture provider loses no-fault case for lack of medical evidence opposing summary judgment motion.
A sighting of “interboard” in action — Read Article →
The denial just has to set forth a fee schedule defense
Court ruling clarifies that insurance companies can raise fee schedule defenses without specific details in denial forms, contrary to recent AAA arbitration trends.
The denial just has to set forth a fee schedule defense — Read Article →
Interesting new regulation fee schedule discussion and an example of sloppiness?
Analysis of Tyorkin v Garrison case discussing New York no-fault insurance regulation fee schedule defenses and NF-10 denial form requirements in 2016 court decision.
Interesting new regulation fee schedule discussion and an example of sloppiness? — Read Article →
CPT Code 97026
Court reverses summary judgment denial for CPT code 97026 infrared therapy billing, reinforcing recent case law favoring healthcare providers in no-fault disputes.
CPT Code 97026 — Read Article →
Supreme Court held that Medicaid fee schedule applies to CPM rental
Supreme Court ruling applies Medicaid fee schedule to CPM rental in no-fault insurance case, potentially ending reasonable and customary charges for providers.
Supreme Court held that Medicaid fee schedule applies to CPM rental — Read Article →
New Jersey fee schedule prevails
New Jersey fee schedule prevails in NY no-fault cases for out-of-state services. Appellate Term ruling on geographic fee schedules and post-2013 defense changes.
New Jersey fee schedule prevails — Read Article →
Coder’s affidavit is sufficient to prove non-conformity with the fee schedule
Court ruling establishes that certified professional coder's affidavit can prove proper fee schedule application, potentially impacting arbitration arguments about coder...
Coder’s affidavit is sufficient to prove non-conformity with the fee schedule — Read Article →
Another old fee schedule 20553 reduction case
Court upholds $4,000 to $645.90 fee schedule reduction for CPT code 20553, explaining Ground Rule methodology and potential carrier recoupment analysis.
Another old fee schedule 20553 reduction case — Read Article →
First application of 11 NYCRR 65-3.8(g)(1)(ii)
Landmark case establishing first application of 11 NYCRR 65-3.8(g)(1)(ii) regarding prevailing fees and timeliness requirements in New York no-fault insurance claims.
First application of 11 NYCRR 65-3.8(g)(1)(ii) — Read Article →
CPT Code 20553 reduced from $4,000 to less than $1,000
NY court reduces CPT Code 20553 billing from $4,000 to under $1,000 using workers' compensation fee schedule Ground Rules 3 and 5 in no-fault insurance case.
CPT Code 20553 reduced from $4,000 to less than $1,000 — Read Article →
Acupuncture may be billed using 97039 and 97026
NY court ruling on acupuncture billing codes 97039 and 97026 in no-fault insurance claims, establishing fee schedule guidelines for licensed acupuncturists.
Acupuncture may be billed using 97039 and 97026 — Read Article →
It came and I am surprised – but if everything is now done in New Jersey, what’s the long term impact?
Court ruling on facility fees for office-based surgery under NY no-fault insurance law, examining Insurance Law § 5108 and Workers' Compensation fee schedules.
It came and I am surprised – but if everything is now done in New Jersey, what’s the long term impact? — Read Article →
Fee schedule vendor properly substituted for a claims rep. affidavit
Court ruling establishes that fee schedule vendors can properly substitute claims representatives in affidavits defending workers' compensation fee schedule determinations.
Fee schedule vendor properly substituted for a claims rep. affidavit — Read Article →
Another acupuncture fee schedule challenge fails
New York court upholds GEICO's fee schedule reductions for acupuncture services, rejecting provider's challenge in workers' compensation case.
Another acupuncture fee schedule challenge fails — Read Article →
New Jersey fee schedule is proper as a matter of law
New Jersey fee schedule properly applied to out-of-state services under NY no-fault law. Court ruling prevents coding battles, establishes clear reimbursement rules.
New Jersey fee schedule is proper as a matter of law — Read Article →
Acupuncture fee schedule defense again
Court ruling shows evolution in acupuncture fee schedule defense standards, moving from procedural comparison requirements to simpler denial efficacy tests.
Acupuncture fee schedule defense again — Read Article →
My encounter with G0283
Long Island no-fault attorney discusses G0283 billing code replacing 97032 electrical stimulation and the need for prima facie burden of proof in fee schedule defenses.
My encounter with G0283 — Read Article →
Fee schedule in New Jersey
New Jersey fee schedule requirements for NY no-fault claims when providers perform services outside New York State under 11 NYCRR § 68.6 prevailing fee regulations.
Fee schedule in New Jersey — Read Article →
Acupuncture paid at physician rate sustained on appeal
NY appellate court sustains acupuncture provider's right to physician rates over chiropractor schedule in no-fault insurance fee dispute case analysis.
Acupuncture paid at physician rate sustained on appeal — Read Article →
Acupuncture fee schedule
New York acupuncture fee schedule case analysis - chiropractor rate reductions, evaluation codes, and physical therapy billing issues in no-fault insurance claims.
Acupuncture fee schedule — Read Article →
Ground rule 11 and the IME cut off
Analysis of Triumph Assoc. Physical Therapy v New York Central Mutual case addressing Ground Rule 11 fee schedule disputes and IME-based medical necessity denials in no-fault law.
Ground rule 11 and the IME cut off — Read Article →
Mr. SK Prime expanded Great Wall
SK Prime Med. Supply case marks first application of Great Wall precedent beyond acupuncture, establishing fee schedule standards for durable medical equipment in no-fault...
Mr. SK Prime expanded Great Wall — Read Article →
Another Civil Kings Judge gets reversed for deciding that Great Wall does not apply
Kings County judge reversed again for rejecting Great Wall acupuncture fee schedule ruling. Appellate Term upholds chiropractor rate limitations for acupuncture services.
Another Civil Kings Judge gets reversed for deciding that Great Wall does not apply — Read Article →
Comp defense succeeds but medical necessity defense falters
Court rules fee schedule defense succeeds with employee affidavit but medical necessity defense fails when plaintiff submits sworn letter from treating chiropractor
Comp defense succeeds but medical necessity defense falters — Read Article →
Medical necessity disputes in major medical disputes may be raised at any time
New York courts require competent expert medical proof to challenge medical necessity in no-fault insurance disputes, with fair and reasonable charges being key factors.
Medical necessity disputes in major medical disputes may be raised at any time — Read Article →
More acupuncture from the First Department
First Department ruling on acupuncture fee schedule disputes in no-fault cases, highlighting importance of proper billing rates and timely denial procedures.
More acupuncture from the First Department — Read Article →
Acupuncture fee schedule from the First Department
First Department ruling on acupuncture fee schedules in no-fault insurance cases, analyzing chiropractor rate limitations and prima facie defense requirements.
Acupuncture fee schedule from the First Department — Read Article →
8 units applies to billing medical providers only?
Suffolk County District Court rules on 8-unit billing limit for medical providers under NY no-fault insurance fee schedule, allowing reimbursement despite multiple claims.
8 units applies to billing medical providers only? — Read Article →
Initial visit compensable
Court ruling highlights insurance companies must address initial evaluation codes separately from routine treatment codes in no-fault insurance disputes.
Initial visit compensable — Read Article →
Chiropractor fee schedule applies to all billed for codes
New York court rules that chiropractor fee schedules apply to acupuncture services regardless of provider type, impacting no-fault insurance reimbursement rates.
Chiropractor fee schedule applies to all billed for codes — Read Article →
Initial visit allowed – open question being how much
Court rules acupuncturists can bill for initial visits under code 99202, but leaves open question about reimbursement rates compared to chiropractors.
Initial visit allowed – open question being how much — Read Article →
The constitutional challenge
New York court rejects constitutional challenge to acupuncture fee schedule in no-fault insurance case, highlighting ongoing disputes over reimbursement rates.
The constitutional challenge — Read Article →
It looks like someone did not include the fee schedule as an exhibit in their acupuncture motion
Insurance companies must properly submit fee schedules as evidence when denying acupuncture claims, or risk having their payment denials overturned by courts.
It looks like someone did not include the fee schedule as an exhibit in their acupuncture motion — Read Article →
Another verification again
New York court ruling demonstrates how insurance companies can successfully defend no-fault claims when healthcare providers fail to respond to verification requests.
Another verification again — Read Article →
An interesting decision on a well known performer of enhanced MUA
Court decision on CPT codes 99455 and 99456 billing abuse in New York no-fault insurance MUA claims, featuring Flatbush Chiropractic v MetLife arbitration award.
An interesting decision on a well known performer of enhanced MUA — Read Article →
Surprised?
New York appellate court reverses lower court decision in Oriental World Acupuncture v GEICO, highlighting the importance of strategic appellate arguments in no-fault cases.
Surprised? — Read Article →
Denial and EOB is sufficient to preserve fee schedule defense
New York court rules that denial letters with EOB forms adequately preserve fee schedule defenses in no-fault insurance disputes, even without explicit notice requirements.
Denial and EOB is sufficient to preserve fee schedule defense — Read Article →
The failure to affirmatively seek judicial notice of the fee schedule (again) proves fatal to a motion for summary judgment
New York court ruling on fee schedule defense failures in no-fault insurance summary judgment motions, highlighting judicial notice requirements for claims examiners.
The failure to affirmatively seek judicial notice of the fee schedule (again) proves fatal to a motion for summary judgment — Read Article →
More MUA – this one is over the top
Court case analysis examining chiropractor MUA billing disputes under NY no-fault fee schedules, including rate limitations and multiple procedure rules.
More MUA – this one is over the top — Read Article →
Renewal granted and Plaintiff loses.
Court grants renewal motion after law office failure, defendant wins summary judgment in no-fault insurance case when plaintiff fails to raise triable issues of fact.
Renewal granted and Plaintiff loses. — Read Article →
Another motion to dismiss an initial acupuncture session is denied
New York Appellate Term denies insurer's motion to dismiss acupuncture provider's claim for initial session, reinforcing provider rights under no-fault law.
Another motion to dismiss an initial acupuncture session is denied — Read Article →
Acupuncture fee schedule (again)
New York appellate court reinforces requirement for insurance carriers to properly submit fee schedules as evidence in acupuncture reimbursement disputes under no-fault law.
Acupuncture fee schedule (again) — Read Article →
Surgical Center does not need to comply with Article 28 to be reimbursed under no fault
Learn about Article 28 licensing requirements for surgical centers in NY. Expert analysis of Upper E. Side Surgical v State Farm case and reimbursement rules.
Surgical Center does not need to comply with Article 28 to be reimbursed under no fault — Read Article →
Acupuncture – the fee schedule is incorporated by reference
NY court rules workers' compensation fee schedule incorporated by reference in no-fault acupuncture cases, establishing precedent for billing code requirements.
Acupuncture – the fee schedule is incorporated by reference — Read Article →
Nothing gives me a bigger headache than reading about acupuncture and the fee schedule
Top 10 arguments about acupuncture fee schedules in NY no-fault insurance law, including court precedent and billing disputes between providers and insurers.
Nothing gives me a bigger headache than reading about acupuncture and the fee schedule — Read Article →
Fee schedule defense not preserved abesent a timely denial
Court ruling demonstrates that insurance companies must timely deny claims to preserve fee schedule defenses in New York no-fault litigation.
Fee schedule defense not preserved abesent a timely denial — Read Article →
WHO?
W.H.O. Acupuncture v Geico case analysis covering acupuncture fee schedule constitutionality, appealable orders, and judgment preparation requirements in NY no-fault law.
WHO? — Read Article →
How much was that anesthesia really worth?
Judge Ciaffa rules on medical provider billing practices, comparing charges to uninsured patients vs. insurance reimbursement rates in Nassau Anesthesia v Chin case.
How much was that anesthesia really worth? — Read Article →
Understanding SAPA Regulations: When Administrative Interpretation Falls Short
Expert analysis of SAPA regulations and administrative interpretation in NY no-fault insurance. Long Island & NYC personal injury attorneys. Call 516-750-0595.
Understanding SAPA Regulations: When Administrative Interpretation Falls Short — Read Article →
Only in no-fault can a Civil Court JHO "reverse" the holdings of the Appellate Divisions and the Court of Appeals
Understand how Civil Court JHOs can challenge higher court precedent through administrative deference in NY no-fault insurance law. Expert legal analysis.
Only in no-fault can a Civil Court JHO "reverse" the holdings of the Appellate Divisions and the Court of Appeals — Read Article →
Chiropractor? fee schedule applied to acupuncture
Learn how chiropractor fee schedules affect acupuncture reimbursement under NY no-fault insurance. Expert legal analysis from Long Island personal injury attorneys.
Chiropractor? fee schedule applied to acupuncture — Read Article →
Prior rulings on acupuncture fee schedule and proof needed to oppose a medical necessity motion stand
New York appellate court clarifies acupuncture billing rates, medical necessity proof standards, and scope of practice in no-fault insurance disputes.
Prior rulings on acupuncture fee schedule and proof needed to oppose a medical necessity motion stand — Read Article →
Acupuncture is reimbursable at the….(fill in the blank)(again)
NY acupuncture reimbursement case: Appellate Term rules on proper billing codes 97810, 97811 and initial consultation fees under no-fault insurance law.
Acupuncture is reimbursable at the….(fill in the blank)(again) — Read Article →
A chiropactor may bill for manipulation under anethesia services – but you knew that already
Civil Court ruling confirms chiropractors can bill for manipulation under anesthesia (MUA) services in no-fault insurance claims with specific rate limitations.
A chiropactor may bill for manipulation under anethesia services – but you knew that already — Read Article →
Give it up already?
Appellate Term Second Department reaffirms acupuncture services reimbursable at chiropractor rates under NY no-fault insurance law, rejecting invalid defenses.
Give it up already? — Read Article →
Another case where the Appellate Term seems to hold that a triable issue of fact is raised regarding the compensability of range of motion testing
Appellate Term ruling creates triable issue of fact regarding separate reimbursement for range of motion testing versus inclusion in office visit services.
Another case where the Appellate Term seems to hold that a triable issue of fact is raised regarding the compensability of range of motion testing — Read Article →
Fee Schedule Defense Requirements in No-Fault Insurance Cases | Long Island & NYC Legal Analysis
Expert legal analysis of fee schedule defense requirements in no-fault insurance cases. Call (516) 750-0595 for experienced representation in Long Island and NYC.
Fee Schedule Defense Requirements in No-Fault Insurance Cases | Long Island & NYC Legal Analysis — Read Article →
Inconsistent Opinions Regarding Range of Motion Fee-Schedule Denials: A Guide for Long Island and NYC Healthcare Providers
Expert legal guidance on ROM and MM testing billing disputes for Long Island and NYC healthcare providers. Navigate inconsistent court decisions and maximize reimbursements. Call...
Inconsistent Opinions Regarding Range of Motion Fee-Schedule Denials: A Guide for Long Island and NYC Healthcare Providers — Read Article →
Defense of unbundling requires coding expert affidavit
Learn why expert affidavits are crucial for defending medical billing unbundling claims in NY no-fault insurance. Essential insights for Long Island & NYC legal professionals. Call...
Defense of unbundling requires coding expert affidavit — Read Article →
Fee Schedule Defenses in NY No-Fault Insurance: St. Vincent Med Care Case Analysis
Analysis of St. Vincent Med Care v Country-Wide Insurance case regarding fee schedule defenses and bundled services in NY no-fault insurance claims for healthcare providers.
Fee Schedule Defenses in NY No-Fault Insurance: St. Vincent Med Care Case Analysis — Read Article →
NY Acupuncture Prima Facie Defense: Chiropractor Rate Limitations Upheld
Learn how NY courts established prima facie defense for acupuncture fee disputes, limiting coverage to chiropractor rates. Expert analysis for Long Island & NYC patients.
NY Acupuncture Prima Facie Defense: Chiropractor Rate Limitations Upheld — Read Article →
NY Acupuncture Fee Schedules: Licensed Practitioners Limited to Chiropractor Rates
Learn how NY courts limit acupuncture practitioners to chiropractor fee schedules in no-fault cases. Expert analysis for Long Island & NYC alternative medicine coverage.
NY Acupuncture Fee Schedules: Licensed Practitioners Limited to Chiropractor Rates — Read Article →
The chiropractor rate is all that an acupuncurist is entitled to
Understanding acupuncture fee schedule requirements in New York no-fault cases. Legal guide on chiropractic rate reimbursement for acupuncture providers.
The chiropractor rate is all that an acupuncurist is entitled to — Read Article →
Acupuncture Reimbursement Rates in New York No-Fault Insurance Cases
Learn about acupuncture reimbursement rates in New York no-fault insurance cases. Important legal precedent affecting NYC and Long Island patients. Call 516-750-0595.
Acupuncture Reimbursement Rates in New York No-Fault Insurance Cases — Read Article →
Fee schedule defense – competent evidence?
NY insurance carriers must provide competent evidence for fee schedule denials. Long Island personal injury lawyer explains OS Tigris case. Call 516-750-0595.
Fee schedule defense – competent evidence? — Read Article →
Fee schedule defense – Appellate Division gives due deference to the DOI
Expert legal analysis on fee schedule defense in New York. Long Island personal injury attorney explains DOI deference and your no-fault rights. Call 516-750-0595.
Fee schedule defense – Appellate Division gives due deference to the DOI — Read Article →About Our Fee Schedule Articles
The Law Office of Jason Tenenbaum publishes detailed legal analysis on fee schedule and related topics as part of an ongoing commitment to legal education and transparency. Since 2008, Attorney Tenenbaum has written over 2,353 articles examining how New York courts decide cases involving personal injury, no-fault insurance, employment discrimination, and complex litigation matters. Each article is based on an actual court decision and provides the kind of substantive analysis that practitioners and clients need to understand the current state of the law.
Attorney Tenenbaum brings over 24 years of New York litigation experience to every article. His practice spans Nassau County, Suffolk County, Queens, Brooklyn, Manhattan, the Bronx, and Staten Island. He has handled thousands of cases involving insurance disputes, personal injury claims, and employment law matters, giving him a practical perspective that academic commentators often lack. The articles in this collection reflect that experience, offering readers insight into how judges actually apply legal standards in contested cases.
If you are dealing with a legal issue related to fee schedule or any topic covered on this blog, the firm offers free initial consultations by phone or in person. Call (516) 750-0595 to speak with an attorney, or visit the contact page to submit a case review request online. No fee is charged unless the firm recovers compensation on your behalf. The firm's six attorneys bring over 112 combined years of legal experience and speak English, Spanish, Italian, Japanese, and Russian, ensuring clients can communicate in the language they are most comfortable with. Attorney Tenenbaum is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as multiple federal courts, and he has authored more than 2,353 published legal articles that attorneys, judges, and insurance professionals across the state rely on for guidance.
Understanding Fee Schedule in New York
New York's legal framework for fee schedule matters involves an intricate web of statutes, regulations, and case law that has developed over decades. The state's court system — including the Civil Court, District Courts, Supreme Court, Appellate Term, Appellate Division, and Court of Appeals — each plays a distinct role in shaping how fee schedule cases are litigated and decided. Trial-level decisions in Nassau County Supreme Court, Suffolk County Supreme Court, and the New York City Civil Courts establish important factual precedents, while appellate rulings create binding legal standards that all lower courts must follow.
The Civil Practice Law and Rules (CPLR) governs procedure in New York civil litigation and contains provisions that directly impact fee schedule cases. CPLR Article 31 establishes the scope and methods of disclosure, including depositions under CPLR 3107, interrogatories under CPLR 3130, and document demands under CPLR 3120. CPLR 3212 provides the standard for summary judgment, requiring the movant to establish a prima facie case through admissible evidence and shifting the burden to the opponent to raise a triable issue of fact. CPLR 3215 governs default judgments, which require proof of service, proof of the facts constituting the claim, and proof of the amount due. Understanding these procedural tools is essential for anyone involved in fee schedule litigation in New York.
Statutes of limitations vary significantly depending on the type of claim. General negligence and personal injury claims carry a three-year deadline under CPLR 214(5). Medical malpractice claims have a shortened two-and-a-half-year deadline under CPLR 214-a. Claims against municipalities require a Notice of Claim within 90 days under General Municipal Law Section 50-e. No-fault insurance claims have their own regulatory deadlines, including the 30-day filing window for applications and the 45-day submission period for provider claims. Employment discrimination claims under the New York State Human Rights Law generally have a three-year statute of limitations, while federal Title VII claims require EEOC filing within 300 days.
The Appellate Term and Appellate Division regularly issue decisions that clarify and refine the legal standards applicable to fee schedule cases. The Second Department, which covers Long Island and parts of New York City, is particularly active in this area. Its decisions on evidentiary standards, burden-shifting frameworks, and procedural requirements directly affect how trial courts evaluate motions and how attorneys prepare their cases. Attorney Tenenbaum monitors these decisions and analyzes them in the articles on this page, providing practitioners with the timely legal commentary they need to stay current.
The Law Office of Jason Tenenbaum, P.C. is located at 326 Walt Whitman Road, Suite C, Huntington Station, New York 11746, centrally situated on Long Island to serve clients throughout Nassau County, Suffolk County, and the five boroughs of New York City. With over 24 years of experience and more than 1,000 appeals written, Attorney Tenenbaum combines deep legal knowledge with practical courtroom experience. If you need help with a fee schedule matter, call (516) 750-0595 for a free consultation.
Key Procedural Considerations
Successful outcomes in fee schedule cases often depend on procedural compliance as much as substantive merit. In no-fault insurance litigation, the prima facie case standard requires the plaintiff to submit admissible evidence establishing the claim was properly submitted, overdue, and unpaid. If the defendant raises a defense — such as an IME no-show, EUO non-appearance, lack of medical necessity, or fee schedule dispute — the burden shifts to the plaintiff to present evidence creating a triable issue of fact. Summary judgment motions under CPLR 3212 require the movant to make a prima facie showing through affidavits, deposition testimony, or documentary evidence, and the opposition must raise a genuine factual dispute to avoid dismissal.
In personal injury cases, the discovery process is governed by CPLR Article 31 and involves depositions of parties and witnesses, exchange of medical records under CPLR 3121 authorizations, physical and mental examinations, and expert disclosure. Once discovery is complete, either party may file a note of issue certifying readiness for trial, after which a 120-day deadline applies for filing summary judgment motions under CPLR 3212(a). Motion practice often determines the outcome of cases before trial, and understanding the specific evidentiary standards applied by courts in your jurisdiction is essential. The articles on this page analyze these standards in detail, drawing on real cases litigated by Attorney Tenenbaum and decisions from courts across the state.
The firm serves clients throughout Long Island, including the towns and villages of Huntington, Babylon, Islip, Brookhaven, Smithtown, Hempstead, Garden City, Mineola, Great Neck, Freeport, Long Beach, Rockville Centre, Valley Stream, Westbury, Hicksville, and Massapequa, as well as all five boroughs of New York City. Attorney Tenenbaum regularly appears in Nassau County Supreme Court, Suffolk County Supreme Court, the New York City Civil Court, the American Arbitration Association, the Workers' Compensation Board, and the Appellate Term and Appellate Division of the Second Department. If you need legal assistance with a fee schedule matter or any topic discussed in these articles, call (516) 750-0595 for a free, confidential case evaluation.
About the Law Office of Jason Tenenbaum
The Law Office of Jason Tenenbaum, P.C. was founded in 2002 and has grown into one of Long Island's most respected personal injury, employment law, and insurance litigation firms. The firm's six attorneys — led by founding partner Jason Tenenbaum — bring over 112 combined years of legal experience to every case. The team speaks English, Spanish, Italian, Japanese, and Russian, ensuring that clients from diverse backgrounds can communicate in the language they are most comfortable with during what is often one of the most stressful periods of their lives.
Attorney Tenenbaum earned his Juris Doctor from Syracuse University College of Law and is admitted to practice in New York, New Jersey, Florida, Texas, Georgia, and Michigan state courts, as well as the United States District Courts for the Eastern and Southern Districts of New York. He has written more than 1,000 appellate briefs, handled over 100,000 no-fault insurance cases, and recovered over $100 million in verdicts and settlements for injured individuals and workers throughout Long Island and New York City. His 2,353+ published legal articles on New York case law make him one of the most prolific legal commentators in the state, and his analysis is relied upon by attorneys, judges, and insurance professionals across all four Appellate Division departments.
The firm operates on a contingency fee basis for personal injury and employment discrimination cases, which means clients pay no attorney fees unless the firm recovers compensation on their behalf. Every consultation is free, confidential, and without obligation. The firm's centrally located Huntington Station office provides convenient access to Nassau County Supreme Court in Mineola, Suffolk County Supreme Court in Riverhead, the Nassau County District Court, Suffolk County courts in Central Islip, and the New York City Civil Court. Whether you need help with a car accident claim, a workplace discrimination complaint, a no-fault insurance denial, a workers' compensation dispute, or any other legal matter, the Law Office of Jason Tenenbaum, P.C. is ready to fight for your rights.
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