October 30, 2019
Physical Therapy Documentation Requirements

Ap plicable to: Mercy Care Complete Care, Mercy Care RBHA, Mercy Care Long Term Care and Mercy Care DD 
When billing for physical therapy services, it's important to clarify documentation requirements. Mercy Care's Program Integrity department would like to share some clarification regarding required documentation for Physical Therapy Services: 
  • When billing time-based CPT codes, the patient’s medical record must have start and stop times for these services in order to validate the appropriateness of the billing. The total time in minutes as well as the time for each procedure must be noted to verify the number of units billed.  Please note that some services cannot be billed within the same 15-minute period. The start and stop time, total treatment time in minutes and minutes billed for each individual service is required.
  • When documenting treatments and/or exercises, details of frequency, and how the exercises contribute to the patient’s plan of care is required.
  • When services are provided, the services must be billed under the provider’s own AHCCCS ID in accordance to the Mercy Care Provider Manual, Chapter 4.04: “MC Provider Relations must be notified if a covering provider is not contracted or affiliated with MC. This notification must occur in advance of providing coverage and MC must provide authorization. Reimbursement to covering physicians is based on the MC Fee Schedule. The covering physician must bill under their own Tax Identification Number. Failure to notify MC of covering physician affiliations may result in claim denials and the provider may be responsible for reimbursing the covering provider.” Additionally, providers should refer to their AHCCCS Provider Participation Agreement which notes that a provider cannot use/bill under another provider’s AHCCCS ID.
  • Billing for therapeutic services that require one-on-one contact must be supported by documentation as per the 2019 CPT, “Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 15 minutes”.  The direct one-on-one contact should be clearly identified within the note.
  • When billing for services, it’s important to ensure the diagnosis is supported by documentation and that the code is as specific to the patient’s condition as possible.

Following the above billing requirements should assist you in achieving timely and accurate payment of your claims. 

As always, don't hesitate to contact your Mercy Care Provider Relations Representative with any questions or comments. You can find this notice and all other provider notices on our Mercy Care website.

We appreciate your continued assistance, support and cooperation!