1. Aetna considers aquatic therapy (hydrotherapy, pool therapy) medically necessary for musculoskeletal conditions.

   Note: Pool, aquatic, or hydrotherapy is considered to be a physical therapy modality subject to the physical therapy guidelines and any applicable plan benefit limits for physical therapy (see CPB 325 - Physical Therapy Services).

   Note: Aetna covers only the professional charges of a physical therapist or other recognized, licensed providers (e.g., doctor of medicine, doctor of osteopathy, podiatrist, and physical therapy assistant), for physical therapy modalities administered in a pool, which require direct, one-on-one, patient contact. Charges for aquatic exercise programs, or separate charges for use of a pool, are not covered.

   Note: Aquatic therapy must be carried out for restoring the member's level of function that was lost or reduced by injury or illness. The provider must have direct (one-to-one) patient contact when reporting aquatic therapy. Supervising multiple patients in a pool at one time and billing for each of these patients per 15 minutes of therapy time is inappropriate.

2. Aetna considers aquatic therapy that is carried out to maintain a level of function (maintenance therapy), where the member is neither improving nor regressing, not medically necessary.

3. Aetna considers aquatic therapy experimental and investigational for the treatment of asthma and all other non-musculoskeletal indications (e.g., autism) because its effectiveness for non-musculoskeletal indications has not been established.

See also CPB 699 - Dry Hydrotherapy (Hydromassage, Aquamassage, Water Massage).

Aquatic therapy has been shown to provide relief of symptoms from a variety of arthritides, traumatic injuries, and other musculoskeletal conditions. This procedure uses the therapeutic properties of water (e.g., buoyancy, resistance). Aquatic therapy may necessary for a loss or restriction of joint motion, strength, mobility, or function which has resulted from a specific disease or injury. The medical record should show objective loss of joint motion, strength, or mobility (e.g., degrees of motion, strength grades, levels of assistance). Standard treatment duration is 3 to 4 times per week for 2 to 4 weeks. It is not necessary to have more than one form of hydrotherapy during the same visit (NHIC, 2002). Other forms of exercise therapy may be necessary in addition to aquatic therapy when the member cannot perform land-based exercises effectively to treat his/her condition without first undergoing the aquatic therapy, or when aquatic therapy facilitates progress to land-based exercise or increased function.