APTA is aware of and actively advocating against Anthem’s policy that requires providers to document time in and time out for each CPT code billed. In a letter to Anthem in May, APTA expressed concern and urged revisions to Anthem’s reimbursement policy titled “Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation Services.” APTA also requested a meeting to discuss the infeasibility of the policy and elaborate on APTA’s desired revisions.
In its letter to Anthem, APTA urged revisions to the policy to reflect total treatment time and total timed code minutes, stating that the requirement for detailed documentation of treatment time by modality is unworkable and inconsistent with evidence-based practice.
APTA emphasized that this requirement serves no purpose and also called for changes to language that merges the Centers for Medicare & Medicaid Services’ 8-minute rule with the AMA CPT midpoint rule, noting that this hybrid cannot be accommodated by existing documentation and billing systems.
APTA is working with state chapters to advocate against the policy with local Anthem leadership. The association encourages all chapters and providers impacted by this policy to express their concerns to Anthem. APTA has created a customizable template letter for chapters and providers addressing Anthem, along with a generic template letter for any payer considering a similar policy.
APTA will continue to vigorously oppose these burdensome and inappropriate policies and is prepared to support each chapter’s advocacy efforts.
For questions or additional information please contact advocacy@apta.org.
