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AetnaAll Plans · Coverage · Medical Policy · Physical Therapy, Orthopedics, Rheumatology +1 moreMedium impact

Pool Therapy, Aquatic Therapy or Hydrotherapy (CPB 0174, reviewed 2026-04-21)

Effective date
Not stated in the notice
Identified
Aug 13, 2026

Summary

Aetna considers aquatic therapy (hydrotherapy, pool therapy) medically necessary for osteoarthritis of the knee or hip, fibromyalgia, ankylosing spondylitis, rheumatoid arthritis, chronic low back pain, or other musculoskeletal conditions when pain, weight-bearing restrictions or poor balance prevent the member from pursuing land-based therapeutic activities or exercises. Aquatic therapy that maintains a level of function, where the member is neither improving nor regressing, is considered not medically necessary. Pool therapy is considered experimental, investigational or unproven for post-stroke pain, asthma and other non-musculoskeletal indications, including stroke rehabilitation, and it is a physical therapy modality subject to physical therapy guidelines and plan benefit limits.

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What to do

Action · 8 steps
01Billing team: Bill CPT 97036 and 97113 only when aquatic therapy is restoring function that was lost or reduced by injury or illness.
02The medical record should document objective loss of joint motion, strength, or mobility (for example, degrees of motion, strength grades or levels of assistance).
03Bill only the professional charges of a physical therapist or other recognized, licensed provider for pool modalities that require direct, one-on-one patient contact.
04Charges for aquatic exercise programs, or separate charges for use of a pool, are not covered.
05The provider must have direct (one-to-one) patient contact when reporting aquatic therapy.
06Do not bill per 15 minutes for each patient when one provider supervises multiple patients in a pool at one time, because the source considers this inappropriate.
07Apply the physical therapy guidelines and any applicable plan benefit limits for physical therapy (see CPB 0325).
08Aquatic therapy for diagnoses listed as not covered, such as neoplasms, sickle cell disorders, lymphedema and psoriasis, is not covered.

Codes mentioned

9703697113G89.29R52Z51.89

Original notice

Pool Therapy, Aquatic Therapy or Hydrotherapy (CPB 0174, reviewed 2026-04-21)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesPhysical TherapyOrthopedicsRheumatologyPain ManagementCode 97036Code 97113Code G89.29Code R52Code Z51.89

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