No-Fault medical claims are generally paid in accordance with the New York Worker’s Compensation Fee Schedule. See Ins. Law §5108; 11 NYCRR 68.1. In the addition to the general Fee Schedule, there are separate Fee Schedules for chiropractors, podiatrists, dentists and psychologists. “If a fee schedule has been adopted for a licensed health provider, the fee for services provided shall be the fee adopted or established for that licensed health provider …” 11 NYCRR 68.1(b)(3).

With respect to acupuncture services, the New York State Department of Insurance (the predecessor to the current Department of Financial Services, or DFS) opined: “Medically necessary acupuncture services that are rendered by a New York licensed acupuncturist are covered expenses eligible for reimbursement under No-Fault pursuant to Section 5102(a)(1) of the Insurance Law.” Ops Gen Counsel NY Ins. Dept. No. 04-01-01. While both the general Fee Schedule and the Chiropractic Fee Schedule currently in effect for no-fault claims contain reimbursement codes for acupuncture services performed by medical doctors and chiropractors certified to perform acupuncture, there is no fee schedule specifically applicable to licensed acupuncturists. The No-Fault Regulations provide, in relevant part, that if the Superintendent of Insurance (now DFS) “has not adopted or established a fee schedule applicable to the provider, then the permissible charge for such service shall be the prevailing fee in the geographic location of the provider subject to review by the insurer for consistency with charges permissible for similar procedures under schedules already adopted or established by the superintendent.” 11 NYCRR 68.5(b).