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Aquatic Therapy

Aquatic Therapy/Exercises – June 14, 2023

CPT: 97113

Aquatic therapy refers to any therapeutic exercise, therapeutic activity, neuromuscular re-education, or gait activity that is performed in a water environment including whirlpools, hubbard tanks, underwater treadmills and pools.

When Reasonable and Necessary

This procedure may be reasonable and necessary for the loss or restriction of joint motion, strength, mobility, balance or function due to pain, injury, or illness by using the buoyancy and resistance properties of water.

Aquatic therapy may be considered reasonable and necessary for a patient without the ability to tolerate land-based exercises for rehabilitation. Aquatic therapy exercises should be used to facilitate progression to land based therapy. The qualified professional/personnel auxiliary personnel does not need to be in the water with the patient unless there is an identified safety issue.

Indications

Aquatic therapy with therapeutic exercise may be considered reasonable and necessary in the treatment of the following conditions:

    • The patient having pain, joint stiffness or muscle spasms resulting from rheumatoid arthritis
    • The patient having had a cast removed or recent surgery and requiring mobilization of limbs
    • The patient having paraparesis or hemiparesis
    • The patient having had a recent amputation
    • The patient recovering from a paralytic condition
    • The patient requiring limb mobilization after a head trauma
    • The patient having the inability to tolerate exercise for rehabilitation under gravity-based weight bearing
    • The patient having fibromyalgia

Counting Minutes

The aquatic therapy treatment minutes counted toward the total timed code treatment minutes should only include actual skilled exercise time that required direct one-on-one patient contact by the qualified professional/auxiliary personnel.

Do not include minutes for the patient to dress/undress, get into and out of the pool, etc.

Limitations

Do not bill for the water modality used to provide the aquatic environment, such as whirlpool in addition to aquatic therapy/exercises.

This code should not be used in situations where no exercise is being performed in the water environment (e.g., debridement of ulcers).

Once a patient can demonstrate an exercise safely, therapists may no longer bill Medicare for the time it takes the patient to perform this now independent exercise.

Exercises in the water environment to promote overall fitness, flexibility, improved endurance, aerobic conditioning, or for weight reduction are non-covered.

Documentation

Documentation must clearly support the need for aquatic therapy greater than eight (8) visits.

    • Justification for use of a water environment
    • Objective loss of ADLs, mobility, ROM, strength, balance, coordination, posture and effect on function
    •  If used for pain include pain rating, location of pain, effect of pain on function
    • Specific exercises/activities performed (including progression of the activity), purpose of exercises as related to function, instructions given, and/or assistance needed to perform exercises to demonstrate that the skills and of a therapist were required.

If the same exercise is performed over a number of sessions, the documentation must describe the skilled nature of the qualified professional’s/auxiliary personnel’s intervention during the therapeutic exercise to support the ongoing medical necessity.

Community Pools

When therapy services may be furnished appropriately in a community pool by a clinician in a physical therapist or occupational therapist private practice, physician office, outpatient hospital, or outpatient SNF, the practice/office or provider must rent or lease the pool, or a specific portion of the pool. 

The use of that part of the pool during specified times needs to be restricted to the patients of that practice or provider.  The written agreement to rent or lease the pool must be available for review on request.  When part of the pool is rented or leased, the agreement must describe the part of the pool that is used exclusively by the patients of that practice/office or provider and the times that exclusive use applies. 

Reference

Centers for Medicare and Medicaid. Benefit Manual Chapter 15 § 220

LCD: Outpatient Physical and Occupational Therapy Services - L34049

LCD: Outpatient Physical Therapy - L34428

About Us

Zachary Edgar JD, LLM is the managing partner for Therapy Comply.  Zachary is a healthcare attorney that specializes in federal and state healthcare regulatory issues particularly for physical, occupational, and speech therapy practices.  

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