“Licensed” Acupuncturists May Bill as PTs

To distinguish from our previous post on Pilates, here are two arbitrations from this week that explain why acupuncturists are allowed to bill as physical therapists.

AA Acupuncture PC, et al and Allstate Insurance Company

AAA Case No. 412009047225, Arbitrator Sandra Adelson
Amount in Dispute: $1,542.16
Award Date: 02/23/10

The arbitrator here first relied on the 04-01-01 Opinion Letter from the General Counsel of the Insurance Department to establish that acupuncture services rendered by a “licnesed” acupuncturist are covered expenses under  Insurance Law § 5102 (a) (1).

As far as the correct fee schedule for a licensed acupuncturist, the arbitrator referenced the fact that the Superintendent has promulgated fee schedules for acupuncture services provided by chiropractors licensed to administer acupuncture and by doctors certified to administer acupuncture.  There is still however, no prescribed fee schedule for a licensed acupuncturist that does not fall into either of those categories.

As such, the arbitrator relied on the decision in Forrest Chen Acupuncture Servs., P.C. v. Geico Ins. Co., 2007 NY Slip Op 50874 (U), 15 Misc 3d 137(a), where the Appellate Term Second Department held that that “the Workers Compensation determination of physical therapy rates was an appropriate interpretation of the applicable charges for acupuncture services.”

Dongsheng  Kang Acupuncture, P.C. and Allstate Insurance Company
AAA Case No. 412009042468, Arbitrator Melissa H. Melis
Amount in Dispute: $631.05
Award Date: 02/24/10

Here too, the arbitrator found that the appropriate amount to be paid to a licensed acupuncturist is what was permitted for a physical therapist.

This was based on the following rule, again from Forrest Chen Acupuncture Servs., P.C. v. Geico Ins. Co., 2007 NY Slip Op 50874 (U), 15 Misc 3d 137(a):

…if the Superintendent of Insurance has not adopted or established a fee schedule applicable to the particular type of 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…