What insurance policy changes affect CPT 97010?

There are 7 tracked policy changes affecting CPT 97010, including updates from Aetna, Sentara Health Plans, Health Net. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 97010?

Payers that have issued tracked updates for CPT 97010 include: Aetna, Sentara Health Plans, Health Net, CareSource, Nevada Medicaid.

How do I get notified when CPT 97010 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 97010. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 97010?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

97010 — Applying heated or chilled packs to your body to reduce pain and improve comfort during physical therapy treatment.: Insurance Policy Changes

97010 Insurance Policy Changes

CPT 97010, in plain terms, covers Applying heated or chilled packs to your body to reduce pain and improve comfort during physical therapy treatment. CPT 97010 is referenced in 7 tracked payer policy changes from Aetna, Sentara Health Plans, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 97010 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Physical Therapy (CPB 0325, reviewed 2026-06-02)

Aetna·Effective Jun 2, 2026

Aetna updated its Physical Therapy Clinical Policy Bulletin (CPB 0325) effective June 2, 2026, clarifying medical necessity criteria, explicitly listing experimental/unproven therapies that are not covered (including kinesio taping, blood flow restriction therapy, virtual reality gait training, and others), and reinforcing documentation requirements. Billing teams must deny claims for listed experimental modalities and ensure PT authorization is based on documented functional improvement within one month or establishment of a home maintenance program.

97010 Insurance Policy Changes

Physical Therapy (CPB 0325, reviewed 2026-06-02)

Authorization Updates - Effective January 1, 2026

25-998 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

25-1000 Streamlining Prior Authorization: Simplifying Processes for Better Efficiency

[Georgia] Prior Authorization Requirement Update

Updates to Limitation Error Codes

Attention Provider Type 60 (School Health Services): Ordering, Prescribing and Referring Requirements Updated