CurrentGeisinger Health PlanPolicy MP044

Aquatic Therapy

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This policy governs coverage and medical necessity criteria for aquatic therapy services for Geisinger Health Plan members across applicable lines of business. It outlines indications, limitations, exclusions, and coding guidance for providers requesting or delivering aquatic therapy.

Policy Summary

PayerGeisinger Health Plan

PolicyAquatic Therapy

Policy CodePolicy MP044

Change TypeNo material changes

Effective Date

Last ReviewNov 1, 2024

Next Review Date

Key ActionObtain a physician order and include documentation of prior failure or inappropriateness of land-based therapy plus physician‑signed goals when requesting aquatic therapy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3CPT/HCPCS codes listed

One-to-oneOne-to-one required

Not coveredNon-musculoskeletal excluded

Progress to land-basedProgression required

Annual

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CurrentGeisinger Health PlanPolicy MP044

Aquatic Therapy

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Sign up for Geisinger Health Plan Policy MP044 alerts

Get alerted when Policy MP044 changes without checking for updates manually.

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Policy Summary

PayerGeisinger Health Plan

PolicyAquatic Therapy

Policy CodePolicy MP044

Change TypeNo material changes

Effective Date

Last ReviewNov 1, 2024

Next Review Date

Key ActionObtain a physician order and include documentation of prior failure or inappropriateness of land-based therapy plus physician‑signed goals when requesting aquatic therapy.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3CPT/HCPCS codes listed

One-to-oneOne-to-one required

Not coveredNon-musculoskeletal excluded

Progress to land-basedProgression required

Annual

Coverage Criteria for Aquatic Therapy

Indications / Medical Necessity

Aquatic therapy is medically necessary for rehabilitation when ALL of the following conditions are met:

Aquatic therapy medical necessity criteria

Provider and supervision
- Service is ordered by a licensed physician and provided under the direct supervision of a licensed physical or occupational therapist or a physical/occupational therapist assistant.
Plan and goals
- Therapeutic interventions are part of an overall treatment plan that includes goals approved and signed by the physician.
Clinical indication
- Member has impairments, functional limitations, or disabilities reasonably expected to be eliminated or minimized by the unique properties of water (e.g., buoyancy, hydrodynamics, hydrostatic pressure).
Inability to tolerate land-based therapy
- Member is unable to safely participate in a fully land-based physical therapy/occupational therapy program due to weight-bearing restrictions, weakness, or pain.
Prior land-based intervention documentation
- Request includes documentation of inappropriateness or prior failure of land-based intervention.
- Request includes long-term goals indicative of land-based objectives.
Periodic evaluation requirements
- Periodic evaluations must document progression to a land-based program.
- Periodic evaluations must document improvement in land-based functional activities.
Skill requirement
- Therapy rendered must require the skills of a physical or occupational therapist.
Standard of care
- Aquatic therapy services rendered are considered acceptable standards of medical practice for the member's condition.

Operational note: All conditions must be met for services to be considered medically necessary.

Maintenance programs and general exercise programs (for example, water walking or water jogging) performed without documented skilled therapeutic intervention are not medically necessary and NOT COVERED. The policy specifically requires documentation that skilled physical or occupational therapy interventions are being provided; absent that documentation, these activities meet the exclusion and should not be billed or authorized as aquatic therapy.

Aquatic therapy provided for non‑musculoskeletal indications (including but not limited to asthma, autism, chronic obstructive pulmonary disease, developmental coordination disorder, end‑stage dementia, lymphedema, and sickle cell anemia) is considered unproven and is NOT COVERED.

Coverage for experimental, investigational, or unproven treatments, services, and procedures is expressly excluded under the member's certificate with Geisinger Health Plan. Services deemed experimental, investigational, or unproven are not covered by this policy and providers should refer to MP015 for the process used to make those determinations.

Prior authorization or pre‑certification requirements may still apply for covered services; exclusion as experimental or investigational is separate from any prior authorization process and will result in denial if the service is not an approved covered benefit.

Aquatic therapy delivered for non‑musculoskeletal indications is considered unproven and therefore NOT COVERED. Examples cited in the policy include asthma, autism, COPD, developmental coordination disorder, end‑stage dementia, lymphedema, and sickle cell anemia.

Additionally, routine maintenance or general exercise in the pool without evidence of skilled therapeutic intervention is not medically necessary and NOT COVERED; documentation must demonstrate skilled PT/OT involvement and a rehabilitative intent to meet medical necessity criteria.

Unproven services that fall outside of an approved clinical trial are specifically excluded under the member's certificate and are not covered. Providers should consult MP015 for definitions and the evaluation process used to determine if a service is experimental, investigational, or unproven.

Even when an intervention has limited evidence, lack of inclusion in an approved clinical trial or designation as unproven means the service will be excluded from coverage regardless of any other documentation submitted.

Coding and Procedure Codes

Associated procedure codesCPT

97113	therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises
97022	application of a modality to 1 or more areas; whirlpool
97036	application of a modality to one or more areas; Hubbard tank each 15 minutes

Coding associated with aquatic therapyCPT

97113	therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with therapeutic exercises
97022	application of a modality to 1 or more areas; whirlpool
97036	application of a modality to one or more areas; Hubbard tank each 15 minutes

Provider Requirements, Authorization, and Documentation

Prior Authorization

Physician order and direct supervision required

Aquatic therapy must be ordered by a licensed physician and provided under the direct supervision of a licensed physical or occupational therapist (or assistant); coverage is subject to member-specific benefit limits and line-of-business provisions.

Order must be from a licensed physician.
Therapy must be provided under direct supervision of a licensed PT/OT or PT/OT assistant.
Coverage is subject to eligibility and contract-specific benefit limits.

Prior Authorization

Check member contract and Geisinger prior authorization rules

Prior authorization and/or pre-certification requirements may apply per the member's contract; check the member's line-of-business benefit document and the Geisinger prior authorization website before providing services.

Verify line-of-business benefit limitations and exclusions (benefit documents supersede this policy).

Definitions

Aquatic therapy definition

TermAquatic therapy

DefinitionAn active therapeutic intervention designed to take advantage of the unique buoyancy, support, and resistance properties of water to reduce joint load, assist movement, decrease swelling, and improve strength, tolerance, flexibility, and endurance with less pain and muscle stress.

Key propertiesUses buoyancy to lessen pressure on muscles and joints; water resistance supports strengthening and tolerance; hydrostatic effects reduce swelling.

Medical Necessity / Medically Necessary definition

TermMedical Necessity / Medically Necessary

Application noteWhen applied to hospitalization, means the member requires acute inpatient care and cannot safely receive adequate care as an outpatient.

Background

Aquatic therapy leverages the physical properties of water—buoyancy, support, and resistance—to reduce joint loading, assist movement, and decrease swelling, allowing patients to perform therapeutic exercise with less pain and muscle stress.

Because water provides buoyant support, it can partially or fully unload weight‑bearing joints; combined with hydrostatic resistance and thermal effects, this environment can facilitate improvement in range of motion, strength, endurance, and functional mobility when land‑based therapy is inappropriate or has failed.

Policy Summary

PayerGeisinger Health Plan

PolicyAquatic Therapy

Policy CodePolicy MP044

Change TypeNo material changes

Effective Date

Last ReviewNov 1, 2024

Next Review Date

Key ActionObtain a physician order and include documentation of prior failure or inappropriateness of land-based therapy plus physician‑signed goals when requesting aquatic therapy.

SourceLink

On This Page

Check Geisinger prior authorization requirements at the Geisinger prior authorization website.

Step Therapy

Document inappropriateness or failure of land-based interventions

Document why land-based therapy is inappropriate or has failed before aquatic therapy is approved; treatment goals must emphasize return to land-based function.

Include documentation of inappropriateness or prior failure of land-based intervention in the request.
Include long‑term goals indicative of land‑based objectives.
When used, goal of aquatic therapy must be restoring the member’s level of land‑based function.

Documentation Required

Include physician order, signed plan, and evidence of land‑based inappropriateness

Follow all required submission steps for authorization and medical necessity: include physician order, evidence aquatic therapy is part of an overall plan with physician‑signed goals, and supporting documentation of inability to safely participate in land‑based therapy.

Submit the physician order with the request.
Attach the overall treatment plan with goals approved and signed by the physician.
Provide evidence the member cannot safely participate in a fully land‑based PT/OT program (e.g., weight‑bearing restriction, weakness, pain).

Documentation Required

Required documentation to support medical necessity

Requests must include physician order and documentation that aquatic therapy is part of an overall treatment plan with goals approved and signed by the physician, plus evidence the member cannot safely participate in fully land‑based therapy.

Physician order.
Overall treatment plan with physician‑signed goals.
Documentation member is unable to safely participate in land‑based PT/OT (weight‑bearing restrictions, weakness, pain).
Documentation of inappropriateness or prior failure of land‑based intervention and long‑term land‑based goals.

Documentation Required

Periodic progress evaluations must show progression to land‑based function

Periodic evaluations must document progression toward a land‑based program and improvement in land‑based functional activities; maintain documentation of one‑to‑one patient contact when reporting aquatic therapy.

Progress notes must show progression to a land‑based program.
Notes must document improvement in land‑based functional activities.
Provider must have direct (one‑to‑one) patient contact when reporting aquatic therapy.

Prior Authorization

Follow prior authorization and pre‑certification procedures

Follow the prior authorization and pre‑certification procedures specified in the member's contract and on the Geisinger prior authorization website when requesting coverage.

Use the member’s contract-specific pre‑certification lists if applicable.
Refer to Geisinger prior authorization site for current requirements.

Denial Risk

Do not request aquatic therapy for non‑musculoskeletal indications

Aquatic therapy requests for non‑musculoskeletal indications (for example: asthma, autism, COPD, developmental coordination disorder, end‑stage dementia, lymphedema, sickle cell anemia) are considered unproven and are not covered; do not submit these as medically necessary indications.

Do not request coverage for aquatic therapy to treat asthma or other non‑musculoskeletal conditions listed.
Refer to MP015 for evaluation of experimental, investigational, or unproven services.

Billing Rule

Concurrent group supervision and one‑to‑one billing prohibited

Do not bill multiple patients supervised concurrently in a pool as one‑to‑one aquatic therapy per 15 minutes; concurrent group supervision and billing in this manner is inappropriate and may be denied.

Maintain one‑to‑one direct patient contact when reporting aquatic therapy.
Do not supervise multiple patients in the pool and bill each as receiving one‑to‑one therapy every 15 minutes.

Denial Risk

Conflicts with benefit limits, exclusions, or missing authorization may cause denial

Services may be denied if they conflict with line‑of‑business benefit limitations or contract‑specific exclusions; lack of required prior authorization or submission of requests for excluded indications can trigger denial.

Verify contract‑specific benefit limitations and exclusions before requesting services.
Obtain required prior authorization/pre‑certification when applicable to avoid denial.