CommercialCoverageHigh impact
Pool Therapy, Aquatic Therapy or Hydrotherapy (CPB 0174, reviewed 2026-04-21)
Aetna·Physical Therapy, Orthopedics, Rheumatology +2 more·Medical Policy
Effective date
Apr 21, 2026
We identified it
Aug 13, 2026
Summary
Aetna's updated pool/aquatic therapy policy (CPB 0174, effective 2026-04-21) clarifies coverage criteria, restricting reimbursement to medically necessary treatment for specific musculoskeletal conditions (osteoarthritis, fibromyalgia, ankylosing spondylitis, rheumatoid arthritis, chronic low back pain) when land-based therapy is not feasible. Maintenance therapy, experimental modalities (marine therapy, crenobalneotherapy, WATSU, nano-bubble hydrotherapy), and non-musculoskeletal indications are explicitly excluded. Billing teams must verify one-to-one provider contact, document functional restoration (not maintenance), and apply physical therapy benefit limits.
Action Required
By 2026-04-21, billing team must: (1) Update billing software to require documentation of medical necessity for CPT 97036 and 97113 claims, limiting coverage to: osteoarthritis of knee/hip (M15.0-M19.9), fibromyalgia (M79.7), ankylosing spondylitis (M45), rheumatoid arthritis (M05-M06), chronic low back pain (G89.29, M54.50-M54.9), and other musculoskeletal conditions where land-based therapy is contraindicated. (2) Implement edits to reject claims for maintenance therapy, post-stroke pain (G89.0), and non-musculoskeletal indications (asthma, COPD, autism, dementia, lymphedema, cancer, neonatal brachial plexus palsy, peripheral artery disease, psoriasis, sickle cell, stroke rehabilitation, traumatic brain injury). (3) Deny any claims for experimental modalities: marine therapy, crenobalneotherapy, WATSU (passive hydrotherapy), or nano-bubble hydrotherapy. (4) Verify provider credentials (PT, MD, DO, podiatrist, PTA only) and enforce one-to-one contact requirement—do not reimburse group/supervision billing for multiple patients per 15-minute increment. (5) Apply standard PT benefit limits per CPB 0325. (6) Providers must document objective loss of motion, strength, or mobility in medical record. Failure to implement will result in claim denials and compliance issues.