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Date: February 18,2026
Anthem BCBS Updates Documentation of Time Requirements
Anthem BCBS has updated their documentation of time requirements. This does impact outpatient physical, occupational, and speech therapy services. In this article, I will answer the following questions:
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Rick, fearing the obvious, I do ask… In Michigan we see a fair amount of people with an Out of State BCBS Anthem Commercial plan. I am assuming that your message above doesn’t ‘just’ apply to in-state providers, but to any provider providing services to an Anthem plan from those States, or…?
Question to consider is if records are requested for review, who will review them and which documents will they use to support the documentation of time requirement?
for the states impacted, is that for the plan state or the service state?
Question to consider is if records are requested for review, who will review them and which documents will they use to support the documentation of time requirement?
Rick, when does this update take effect? For Connecticut I still see the following in what is posted on the Anthem website:
Total treatment time, including the beginning and ending time of the direct treatment for
each modality, must be recorded in the member’s medical record, along with the note
describing the specific modality or procedure.
What is on the website has an effective date of 12/11/2024 so I am guessing there is a new revision that has not been uploaded yet?
I had a dyslexic moment and reversed the states with the policies. I have updated the article. Thank you!
To confirm, are you stating that each CPT/modality needs its own in and out time, e.g. 0800-0810 for a 10 minute ultrasound, 0810-1033 for 23 minutes of ther ex, etc.?
Read the answer to the 4th question and it tells you what is required for each modality.
We see that APTA is listing on 2/24/25: Anthem BCBS of Wisconsin has updated its policy for Timed Code billing as follows:
Previously Anthem required recorded start and stop times for each time-based procedures.
Now – Anthem BCBS “Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation Services” commercial reimbursement policy that states “Total treatment time, for each modality, must be recorded in the member’s medical record, along with the note describing the specific modality or procedure”.
there is no distinction between commercial plans vs Medicare advantage plans in this statement.
Can you please provide some clarification between the 2 plan types
Read the answer to the last question and it gives you instructions how to access the policies for Commercial and for Medicare Advantage.
To clarify, is it California and Virginia that the start and stop times still apply to, or California and New York?
California and Virginia; however, each therapist and provider needs to check the applicable policies for their state(s) for both Anthem BCBS Commercial and Anthem MA Medicare Advantage.