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
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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.
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Provider Taxonomies:
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