Summary & Overview
CPT 97113: Aquatic Therapy with Therapeutic Exercises
CPT code 97113 is a nationally recognized billing code for aquatic therapy with therapeutic exercises, a specialized intervention within physical medicine and rehabilitation. This code is used by physical therapists and rehabilitation practitioners to document and bill for water-based therapeutic exercise sessions, typically lasting 15 minutes per area treated. Aquatic therapy is valued for its ability to reduce joint stress and enhance mobility, making it a key option for patients with pain, muscle weakness, difficulty walking, or osteoarthritis.
Major payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a comprehensive overview of payer coverage, clinical indications, and billing practices for CPT 97113. Readers will gain insight into relevant modifiers, associated provider taxonomies, and common ICD-10 diagnoses linked to aquatic therapy. The article also clarifies related CPT codes and outlines policy updates impacting reimbursement and compliance.
This summary equips healthcare professionals, billing specialists, and policy analysts with essential information on the clinical context, payer landscape, and coding requirements for aquatic therapy services, supporting accurate documentation and understanding of national trends.
CPT Code Overview
CPT 97113 represents aquatic therapy with therapeutic exercises, performed in one or more areas for each 15-minute session. This procedure is classified under Physical Medicine and Rehabilitation – Therapeutic Procedures and is commonly delivered in an outpatient physical or occupational therapy clinic setting, such as an office (POS 11). Aquatic therapy utilizes water-based environments to facilitate therapeutic exercises, supporting improved mobility, strength, and function for patients with a range of musculoskeletal and neurological conditions.
Clinical & Coding Specifications
Clinical Context
A patient presents to an outpatient physical therapy clinic with complaints of pain and difficulty in movement, such as pain in the right knee, low back pain, muscle weakness, or difficulty walking. The physical therapist evaluates the patient and determines that aquatic therapy with therapeutic exercises is appropriate. The patient participates in a structured session in a therapeutic pool, where exercises are performed to improve strength, flexibility, and mobility. Each session lasts at least 15 minutes and is supervised by a licensed physical therapist or physical therapy assistant. The aquatic environment is used to reduce joint stress and facilitate movement for conditions such as unilateral primary osteoarthritis of the right knee or generalized muscle weakness.
Coding Specifications
-
Modifiers:
59- Distinct Procedural Service: Used when aquatic therapy (97113) is performed as a separate and distinct service from other procedures on the same day.GP- Services delivered under an outpatient physical therapy plan of care: Indicates that the service is part of a physical therapy plan.
-
Provider Taxonomies:
| Taxonomy Code | Specialty Name |
|---|---|
225100000X | Physical Therapist |
225200000X | Physical Therapy Assistant |
225400000X | Rehabilitation Practitioner |
These taxonomies represent professionals qualified to deliver aquatic therapy and therapeutic exercises.
Related Diagnoses
-
M25.561- Pain in right knee- Relevant for patients experiencing knee pain, which may benefit from aquatic therapy to reduce joint stress during exercise.
-
M54.5- Low back pain- Aquatic therapy can help patients with low back pain by providing a supportive environment for therapeutic movement.
-
M62.81- Muscle weakness (generalized)- Patients with generalized muscle weakness may use aquatic therapy to safely perform exercises and build strength.
-
R26.2- Difficulty in walking, not elsewhere classified- Aquatic therapy assists patients with gait and mobility challenges by reducing weight-bearing and facilitating movement.
-
M17.11- Unilateral primary osteoarthritis, right knee- Aquatic therapy is beneficial for osteoarthritis patients, especially in the knee, by allowing exercise with less pain and joint stress.
Related CPT Codes
97022- Whirlpool (water modality): Used for water-based modalities but should not be billed in addition to97113as both involve aquatic environments.97110- Therapeutic exercises: Focuses on strength, endurance, range of motion, and flexibility; may be used in conjunction with or as an alternative to97113when exercises are performed outside of water.97112- Neuromuscular re-education: Addresses movement, balance, coordination, posture, and proprioception; can complement aquatic therapy or be used separately for targeted neuromuscular training.97116- Gait training: Includes stair climbing and walking exercises; may be performed alongside aquatic therapy or as an alternative for patients needing gait improvement.
97022 is not billed with 97113 due to overlap in service. 97110, 97112, and 97116 may be used together or as alternatives depending on patient needs and clinical goals.
National Reimbursement Benchmarks
For aquatic therapy services billed under CPT 97113, the national mean rate for Medicare is $38.40, while the average commercial rate (BUCA) stands at $42.77. Commercial payers such as Cigna and UnitedHealth Group offer higher mean rates, with Cigna at $48.31 and UnitedHealth Group at $48.14, compared to both Medicare and BUCA.
Rate dispersion, measured by the difference between the 75th and 25th percentiles, varies across payers. Medicare exhibits the tightest range at $4.00, indicating relatively consistent reimbursement. In contrast, Cigna shows the widest dispersion at $30.50, reflecting greater variability in rates. Blue Cross Blue Shield and BUCA also display broader ranges, at $20.88 and $19.17 respectively.
The table and chart below present a detailed breakdown of national benchmarks for each payer, including mean rates and percentile values.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.