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Billing for Aquatic Therapy
Without Getting Soaked

With the appearance of a Physician's Current Procedural Terminology (CPT) Code for "Aquatic Therapy" in 1995, there was an increase in the number of individuals billing for therapy performed in an aquatic medium.

In part, this is merely a byproduct of the new nomenclature. In other words, therapists who were already performing therapy in an aquatic medium altered their billing practices to represent the aquatic nature of their treatment.

However, this phenomenon is not solely responsible for the increase. Providers who would not have felt comfortable billing insurance under CPT codes for "Therapeutic Exercise," "Gait" or "Traction" began billing under the Aquatic Therapy code.

It has not helped that the term "therapy" is not legally defined or protected. "Aquatic Therapy" is a generic term and is not exclusive to a single discipline.

[Note: Terms such as "aquatic physical therapy," "aquatic physical therapist," and "aquatic PT" do include protected terms. The phrases "physical therapy," "physical therapist," or "PT" cannot be used by any provider except a licensed physical therapist. The same is true for use of other professional titles].

The payer's confusion
Health care providers such as athletic trainers, kinesiotherapists, massage therapists, physical and occupational therapists and therapeutic recreation specialists have legally-recognized scopes of practice under which they operate — whether on land or in water. Additionally, such providers have professional organizations with Codes of Ethics and Practice Acts (which are often more stringent than legal standards).

In contrast, an "aquatic therapist" has no legal definition, has no legal scope of practice and no code of ethics. This has led the American Physical Therapy Association to their current practice of calling PTs who work in the pool "physical therapists with expertise in the field of aquatic therapy" in an attempt to educate payers about the difference in aquatic services. Other professions should follow suit.

However, insurance companies are still confused, and are reacting to the influx of "aquatic therapy" charges with skepticism. This skepticism has led many companies to begin a policy of denying all aquatic intervention, irrespective of the provider. Some providers have found that it has gotten "so bad" that the payer no longer cares if the provider is a legally-recognized provider or not. They just deny across-the-board.

The provider's responsibility
The most important step to nipping this trend in the bud is to educate the payer about the nature of aquatic therapy.

For example: It is important to recognized that aquatic physical therapy is, quite simply, PT in water. The same is true for occupational therapy. Aquatic OT is still occupational therapy — the patient just happens to get wet.

The same can be said to be true for all health care professions with a legal capacity to perform health care services — and a scope of practice which encompasses aquatic therapy.

Although aquatic intervention certainly requires esoteric technical skills, aquatic therapy is not a unique professional body of knowledge. This is why the concept of an "aquatic therapist" is a misnomer. There exist, legally, only the health care disciplines which are already recognized under various state codes and by individual professional practice acts.

When an athletic trainer steps into the pool, he becomes an ATC who chooses to use water to perform therapeutic interventions covered under his legal "scope of practice." He doesn't become a new creature, a new discipline. When a CTRS addresses the impairments, functional limitations and disabilities of a given patient, he may choose the aquatic environment in order to harness the unique properties of water to meet the patient's specific recreational needs. This is still therapeutic recreation. No more, no less. If the payer is willing to pay for the same service on land, they should be willing to reimburse for treatment in any medium -- as long as the treatment is justifiable.

Most disciplines have a professional organization designed to assist members with these types of questions. A caveat: if you're not a member, don't expect free assistance, even if you are the same discipline. These organizations exist to serve their paying membership. Find the US professional organizations below.

American Kinesiotherapy Association (704) 259-9666
American Occupational Therapy Association (301) 652-2682
American Physical Therapy Association (334) 990-5713
American Speech-Language-Hearing Association (301) 897-5700
American Society of Exercise Physiologists (new org. launched 1997) (218) 723-6297
American Therapeutic Recreation Association (703) 683-9420
American Massage Therapy Association (847) 864-0123
Associated Bodywork and Massage Professionals (303) 674-8478
National Athletic Trainers' Association (214) 637-6282
National Therapeutic Recreation Society (703) 578-5548

Rumors and where to find out more
There have been some rumors making the rounds about the 1999 CPT code changes. Some of them are true; others are not. The American Medical Association (AMA) is the author and creator of the Current Procedural Terminology (CPT) codes. They are available to answer your specific coding questions for a fee (currently $35 for 3 coding questions). Contact the AMA at (800) 621-8335 to request CPT information.

Or, simply order our resources guide just for aquatic therapy providers Billing for Aquatic Physical Therapy).

Rumors about Aquatic Therapy and CPT codes:

  • Rumor: The CPT code for aquatic therapy (97113) has been modified from a 15-minute code (similar to therapeutic exercise) to a non-timed or single-use code (similar to hot packs). False.

  • Rumor: The CPT code for aquatic therapy (97113) cannot be used in conjunction with other codes to describe a single session of treatment. False.

  • Rumor: The codes for myofascial release, mobilization and manipulation, and manual traction have been deleted and can no longer be used to describe land-based or aquatic intervention. True.

  • Rumor: The code for massage (97124) has been deleted and can no longer be used to describe land-based or aquatic massage (such as Watsu®). False.

  • Rumor: The CPT code for aquatic therapy can be used to describe simultaneous treatment provided by one practitioner to multiple patients. False.

  • Rumor: The group therapy and direct patient contact codes should not be used together to describe a single bout of treatment. False.

  • Rumor: It is appropriate to charge for aquatic therapy differently depending on whether the patient is self-paying, or insurance is being billed. False.

The American Medical Association currently recognizes aquatic therapy as a valid therapeutic procedure (CPT code 97113). Therapists and other providers must educate themselves to make sure they are operating within their legal scope of practice and can rightly seek reimbursement.

Read More on this Topic
The above information was excerpted from the Aquatic Resources Network "Billing for Aquatic Physical Therapy: Tackling Aquatic Therapy Practice and Reimbursement Issues". To read much more on this topic, order this valuable reference book online or call ARN at (715) 248-7258 to order by phone.

The information presented in this article is meant to be a summary and educational in nature. It is not meant to serve as a substitute for legal advice.

Author Bio
Andrea Poteat Salzman, MS, PT is the owner of two businesses, the Aquatic Resources Network and Concepts in Physical Therapy. She has received both the prestiguous Aquatic Therapy Professional of the Year Award (Aquatic Therapy and Rehabilitation Institute) and the Tsunami Aquatic Therapy Award.

Salzman is well-regarded within the industry as:

  • Editor-in-Chief of an aquatic therapy trade journal and newsletter;
  • Author of over a dozen publications, including the soon-to-be-released Evidence-Based Aquatic Therapy textbook;
  • Freelance author and columnist;
  • Aquatic therapy seminar instructor;
  • Adjunct faculty and research advisor, St. Catherine Physical Therapy Program, Minneapolis, MN;
  • Immediate past manager of therapeutic aquatics, St. Paul Ramsey Medical Center, St. Paul, MN;
  • Researcher and grant recipient examining aquatic exercise vs. land-based exercise.

She may be reached via e-mail at

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