After advocacy efforts from APTA staff and members, Anthem has changed its reimbursement policy so that PTs are no longer required to document start and stop times for each CPT code. 

In a letter to Anthem in May, APTA expressed concern and urged revisions to Anthem’s policy titled "Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation Services." APTA’s letter suggested that the policy change to reflect total treatment time and total timed code minutes, stating that the requirement for detailed documentation of treatment time by modality is unworkable, inconsistent with evidence-based practice, and serves no purpose. 

Additionally, APTA called for changes to policy language that merged the Centers for Medicare & Medicaid Services' 8-minute rule with the American Medical Association CPT midpoint rule, noting that this hybrid cannot be accommodated by existing documentation and billing systems.

To support advocacy efforts on the issue, APTA created a customizable template letter for chapters and providers addressing Anthem, along with a generic template letter for any payer considering a similar policy. Several members and practice owners engaged in advocacy with Anthem, including through use of the template letter.

"APTA advised Anthem that requiring the provider to document 'total treatment time, including the beginning and ending time of the direct treatment for each modality' was unfeasible and entirely inconsistent with the evidence-based and safe practice of physical therapy," said Alice Bell, PT, DPT, APTA senior specialist in health policy and payment. "APTA thanks all of our members who advocated on this issue and appreciates Anthem’s updates to the policy."

Anthem’s policy had been in effect since Dec. 11, 2024. The revised policy went into effect on Aug. 13. Anthem California uses "total treatment time, for each modality" as its documentation language, but APTA is working with the insurer to adopt the policy that went into effect on Aug. 13 among all other Anthem networks.

APTA will continue to vigorously oppose any burdensome and inappropriate policies and is prepared to support each chapter’s advocacy efforts. Learn about advocacy wins and stay up to date with advocacy opportunities by joining the APTA Advocacy Network.

For questions or additional information please contact advocacy@apta.org.