Billing Code Information - Summary
 (for details please see the following 7 pages)
 · 97113 Aquatic Therapy
 · 97110 Therapeutic Exercise
 · 97112 Therapeutic Procedure (neuromuscular reeducation etc.)
 · 97530 Therapeutic Activity (to improve functional performance)
 · 97150 Group Therapy (2-5)
 · 97140 Manual Therapy Techniques

 · 97001 P.T.Evaluation
 · 97002 P.T.Re-evaluation
 · 97750 Physical Performance Test or Measurement
 
Workmen's Comp:
 · 97240 Pool Therapy
 · 97241 Pool Therapy-addtl. 15 min.
 
Typical treatment duration: 30 min.
Amount of visits per patient: 6-9
Typical reimbursement / treatment: 50-$75

Med-Fit / Galaxy Pool Customers
Attached is the most recent CPT and reimbursement information
garnered from the Aquatic Physical Therapy Section of the
 APTA. This information was presented at the Annual
Convention in Washington D.C. in June 1999.
We hope you find this information helpful.
Please call us if we can be of any assistance.
Thank You!
 

Reimbursement Strategies
Aspayers scrutinize charges for aquatic therapy more closely, the most important thing therapists can do to maximize reimbursement is to  APPROPRIATELY select patients for therapeutic interventions in the aquatic environment. Therapists must determine whether the interventions being provided in the aquatic environment are truly SKILLED in nature.

Skilled Aquatic Physical Therapy/Patient Selection Requires:

 · The clinical reasoning and decision making skills of a Licensed physical therapist

 · That the patient have impairments and disabilities which

  Can be minimized or eliminated with aquatic physical Therapy

 · That the patient has the potential for achieving the stated Functional goals/outcomes which improve quality of life  And ease the burden of care; the therapy program should
Have goals and a reasonable plan of care related to these  Goals

 · That the patient is unable to safely participate in a  Physical therapy program on land due to weight: Bearing limitations, or severe weakness

 · That the patient would benefit from the therapy in the Aquatic environment because of the unique properties of water, i.e. buoyancy, hydrodynamics, and  hydrostatic pressure

 · that the intervention in the aquatic environment will  enable the patient to transition to an exercise or functional training program on land and possibly facilitate an overall shorter episode of care

 CLINICAL EXAMPLES OF SKILLED THERAPY

  · patient with arthritis who cannot ambulate on land because of the inability to use an assistive device but who can begin walking in the pool

  · patient with THR with weight-bearing restrictions who cannot follow these precautions safely on land

 · patient with Guillain Barre who is too weak to exercise  on land but who can move in the pool with buoyancy assistance..

 EXAMPLES OF NON-SKILLED THERAPY

 · water walking or jogging programs for cardiovascular conditioning for fitness

  · exercise programs to maintain function rather than improve it - (e.g. arthritis association community exercise program)

 · swimming programs for patients with difficulty using Community pools  either due to access or temperature

 Payer Requirements When Billing for Aquatic Physical Therapy
 It is recommended that aquatic therapy providers call  each payer at the time of patient registration to determine if aquatic therapy is reimbursable. The physical therapist or billing coordinator should make a  notation of date, time of call, and with whom you spoke. Inquire if 97113 is an acceptable CPT code for their system. Obtain pre-certification if necessary.

 · payers will only reimburse for one evaluation for the patient for each episode of care for a given diagnosis and this evaluation should be performed on land followed by a screening evaluation in the pool

  · some payers (e.g. Medicare ) will not reimburse for group therapy because they do not feel that this is skilled care; if the client is receiving both group and one on one care on the same date of service then the modifier code 59 should be used
 . payers need justification of the need for physical therapy in the aquatic environment within the submitted therapy documentation, i.e. proof that intervention in the aquatic environment will lead to better and/or faster outcomes than therapy on land, or at least a logical  argument for selecting the aquatic environment

 · payers need documentation that shows that the patient is being transitioned to therapy on land as soon as his/her condition allows, they will not pay for ongoing therapy in the pool in the absence functional progress

 CPT Codes for Physical Therapy in the Aquatic Environment

 There are 9 CPT codes which can be used to bill for physical therapy in the aquatic environment and these will be reviewed below; remember that CPT codes are NOT discipline specific

1. 97113 AquaticTherapy

 · total relative value unit (RVU) 0.66

 · one-on one direct patient contact

 · while therapist does not necessarily need to be in the water with the patient, therapist does need to be within arm or ears reach or in direct contact with the patient (forexample if a patient is doing deep water walking in the deep end of the pool and the therapist is at the opposite end of the pool working with another patient pool side, one cannot bill for skilled aquatic therapy for the patient aqua walking; if the  therapist is pool side instructing a patient in aquatic exercise, this is considered a skilled  intervention and would qualify for reimbursement )

 · timed units of 15 minutes

. could be used for the following interventions - mobility or strengthening exercises, as well as functional mobility training

 · some payers are denying all charges submitted under this code challenging the efficacy of aquatic therapy

 THERE ARE SEVERAL CPT CODES NOT RESTRICTED TO EXERCISE IN THE POOL ENVIRONMENT WHCH CAN BE USED TO BILL FOR AQUATIC PHYSICAL THERAPY INTERVENTIONS. ALL OF THESE CODES REQUIRE ONE-ON-ONE THERAPY. ALL OF THESE CODES ARE TIMED 15 MINUTE CODES. THEIR USE IS CLARIFIED BELOW
 2. 97110 Therapeutic Exercise

 · total relative value unit (RVU) 0.60

 · while therapist does not necessarily need to be in the water with the patient, therapist needs to be within arm or ears reach or in direct contact with the patient

 · could be used for the following interventions -stretching and exercise to increase ROM, flexibility and strengthening, postural and cardiovascular and cardiopulmonary exercise
 
3. 97112 Neuromuscular-education
 · could be used for interventions that improve balance, coordination, kinesthetic sense, posture & proprioception

 · total relative value unit (RVU) 0.59

 · while therapist does not necessarily need to be in the water with the patient, therapist needs to be within arm or ears reach or in direct contact with the patient

  ·  could be used for the following interventions - activities to reduce hyper tonicity, balance exercises, coordination exercises, PNF (Bad Ragaz), Halliwick, and WATSU under certain  circumstances

4. 97530 Therapeutic activities to improve functional performance
. total relative value unit (RVU) 0.63

 · while therapist does not necessarily need to be in the water with the patient, therapist needs to be within arm or ears reach or ~n direct contact with the patient)

  · could be used for the following interventions - training bending and lifting, carrying, reaching activities

5. 97150 Therapeutic Procedure (Group) :
 · not specifically designated to  aquatic therapy but can be used to bill for group interventions in the pool environment

 · total relative value unit (RVU) 0.49

 · limited to groups of up to 5 patients

 · while therapist does not necessarily need to be in the water with the patient, therapist needs to be within ann or ears reach or in direct contact with the patient

 · not a timed unit - one charge regardless of the length of  the intervention

6. 97140 Manual Therapy Techniques :
 · this code replaces 5 codes effective January, 1999. They  include 97122 manual traction, 97250 myofascial release,97260 regional manipulation, 97261  supplemental manipulations, and 97265 joint mobilization

 · this code should be used for mobilization,manipulation, manual lymphatic drainage, myofascial release, and manual traction done in the aquatic environment

 · total relative value unit (RW) 0.63

 · this is a timed unit for 15 minutes of therapy

 Billing for Evaluation in Aquatic Physical Therapy

  IF THE PATIENT IS ONLY BEING TREATED IN THE AQUATIC ENVIRONMENT THEN THERE IS THE POTENTIAL TO BILL FOR AN EVALUATION IN THE AQUATIC ENVIRONMENT

 7. 97001 Physical therapy evaluation
· there is no timed unit attached to this code

 · this code can be used ONLY if the patient has not had an evaluation or treatment for the given diagnosis within thepast 30 days

  · if the patient is only being seen in. the pool then the initial evaluation should address both function on land as well asfunction in the water

  · the therapist must build a strong case for why the patient cannot be treated on land and will be seen only in the aquatic environment

 8. 97002 Physical therapy re-evaluation

  · there is no timed unit attached to this code

 · the re-evaluation code can only be used every 30 days

 · when using this code it is imperative to establish new/ revised therapy goals and treatment plans

 · if the patient is only being seen in the water for longer than 30 days, the therapist must document why the patient cannot be treated on land and will continue to be seen only in the aquatic environment; it is also a good strategy to indicate when the patient is expected to  transition to a land based program

9. 97750 Physical Performance Test or Measurement

 · if the patient is being treated on land as well as in the pool, and a land evaluation has been billed for, some  therapists have been successful in being reimbursed for the pool evaluation and screening using the special tests code

  Dealing with Denials For Aquatic Physical Therapy

 1. Review your documentation

 · is therapy skilled?

 · did you justify why the aquatic intervention is more appropriate than a land intervention ?

 · can the patient participate in land based therapy?

. is the patient making functional gains? (are your goals Written to demonstrate an increase in function rather than An increase in ROM or strength, which may have no Functional significance?)

  · is there a plan to transition the patient to a land based program?

 · has the patient been (pre)certified for therapy?

 If you answer "no" to any of the questions above, it may be difficult to reverse the denial.

 2. If you answered "yes" to all the questions in number 1 above, then you should appeal the denial with the payer,emphasizing the skilled nature of the therapy, the medical necessity for the aquatic environment, the progress/functional gains made by the patient, the time table for transition to land based therapy, the expertise of the provider, and any statistics you may have on the efficacy of the intervention you provided to other patients with the same diagnosis and problems. If there is an article on the efficacy of the intervention you provided and the results are completely supportive, then include  the article. If the article is inconclusive or has even one negative comment then do notsend it with your appeal. Also include any physician referral that requests aquatic therapy.

  3. If you or the patient feel that essential services have been denied, then both the provider and the patient have the right toappeal under their ERISA rights. The patient may want to contact  his/her benefit's administrator.

 4. If you as a provider feel that essential services have been denied, then you can file an appeal with the local insurance commision.

Revised 4/ 30 / 99