97113 CPT Code: Know Your Codes
97113 CPT Code Description: Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with therapeutic exercises. This procedure uses the therapeutic properties of water (e.g., buoyancy, resistance). Hydrotherapy is useful in post-operative extremity (joint) rehabilitation (e.g., total hip or knee arthroplasty, total shoulder, elbow, and wrist arthroplasty). Most Payers will consider aquatic therapy that is carried out to maintain a level of function (maintenance therapy), where the member is neither improving nor regressing, not medically necessary.
- Aquatic therapy (CPT code 97113) should not be billed in situations where no exercise is being performed in the water environment (e.g., debridement of ulcers).
- Most of the Payers will consider pool, aquatic, or hydrotherapy as a physical therapy modality.
- Professional charges of a physical therapist or other recognized, licensed providers (e.g., doctor of medicine, doctor of osteopathy, podiatrist, and physical therapy assistant), for physical therapy modalities administered in a pool, which require direct, one-on-one, patient contact.
- Charges for aquatic exercise programs, or separate charges for use of a pool, are not covered.
- Aquatic therapy with therapeutic exercise (97113) should not be billed when there is not one-on-one contact between therapist and patient. For example, an aqua aerobic class of more than one patient with the instructor directing the class from a distance would not be considered reasonable and necessary and therefore, not a covered service.
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