You have probably heard that water offers a unique therapeutic environment

which can be harnessed to permit activities that are unachievable on land.

Aquatic therapy seems to be “all the rage” these days. It is diffi cult to know

exactly how often aquatic therapy is being used overall, but we do have

a clear picture of how often it is billed under Medicare outpatients claims.

Aquatic therapy is listed as the 14th most frequent outpatient therapy code

billed through Medicare (CMS, 2013). In short, aquatic therapy represents just

under 1% of all Medicare Part B codes billed by private practice PTs.

One percent may not sound like much, but take a moment to consider the

not-insignifi cant barriers to the provision of aquatics (e.g., the need for a large

body of disinfected water and therapists routinely willing to don swimsuits in

December). One percent represents about 1.1 million PT treatments in a year

and that number only represents treatments billed out to Medicare Part B.

(CMS, 2013) The addition of charges billed to commercial payers, worker’s

compensation, Medicaid, and even Medicare Part A would certainly explode

that figure.

In the OT world, aquatics is not currently as popular, coming in at a fraction of

the PT rate – under 0.1% of the total claim lines (11,724 out of 29,032,353 in the

year studied). Interestingly, aquatic therapy appeared on exactly 1 SLP claim

line out of 6,946,174 during this same year. Why just 1? Speech & language

pathologists typically use traditional “speech-related” codes instead of the

aquatic therapy code to represent their in-water work.

HOW POPULAR IS AQUATIC THERAPY?

All told, aquatic therapy represented approximately .7% of total claim lines,

across PT, OT, and Speech disciplines as examined in a 2013 publication. How

did this break down by discipline? Aquatic therapy, billed under the CPT code

97113, appeared on 1,175,315 PT claim lines which represents about .9% of all

outpatient PT claims for that year. So, aquatic therapy represented slightly under

1% of all interventions that PTs chose to use that year.

Was aquatic therapy more popular in one setting over another? In the private

practice arena, physical therapists billed out using the code 97113 about 1% of

all claims. Hospital-based outpatient visits were much more likely to be billed

as therapeutic exercise or manual therapy than for aquatic therapy, with 39.9%

of all claim lines billed for therex, 13.6% for manual therapy, and 1.9% for aquatic

therapy, respectively. (Silver et al, 2013)

It seems that aquatic therapy has taken root in physical medicine and

rehabilitation. Let’s take a look at what makes water-based therapy so different

and then move towards understanding how these special properties of water

make so many novel “specialty techniques” possible.