If you are considering putting in your own therapy pool, it is best to first contact your State's Health Department to determine what requirements and regulations exist. If you want to lease a pool, you must develop a comprehensive written agreement with the facility. The APTA Academy of Aquatic Physical Therapy has a manual for sale on how to start an aquatic physical therapy program. This tool may help you in the planning stage and guide you in making important decisions regarding patient safety and policies.

The correct code for billing aquatic physical therapy services is 97113. This is a timed code that includes therapeutic exercise, allowing one unit for each 15 minutes of direct service. Other codes may be added to 97113 if the billing modifier -59 is used and the documentation supports the medical necessity of the treatment.

It is possible to bill for land and aquatic-based physical therapy services on the same day but documentation must support the medical necessity of the treatment and therapists should consult each payer's policy on reimbursement for both services in a single day.

CPT code 97113 is the correct code used to bill for aquatic physical therapy. The code includes therapeutic exercise. Billing for aquatic physical therapy using codes other than 97113 is fraudulent and referred to as "coding around."

The decision on what type of pool to use depends upon the needs of the patient and the overall population served. Considerations should include the depth of the water, temperature of the water and facility, methods of entry and exit, changing areas, the availability of a dedicated space for aquatic therapy participants, separated from the general population, and the general safety of the facility.

Therapists or therapy providers may rent all or part of a community pool to deliver aquatic therapy services if there is a written agreement and the availability of a separate area in which to provide services. If a portion of a pool is rented, a rope may separate the area. Therapists should first review the benefit information for each patient's individual insurance company to ensure compliance and consideration for reimbursement.

For facilities that bill for aquatic physical therapy, only licensed physical therapists and physical therapist assistants perform treatments. Individual payers usually include language regarding the criteria for therapist involvement in the treatment and for coverage for patients/beneficiaries. The APTA Academy of Aquatic Physical Therapy does not have written guidelines for therapists who treat in the therapy pool, but the academy supports best practice guidelines for achieving and maintaining the highest quality of care for each individual.

There may be instances when the therapist may be at poolside rather than in the pool but therapists must first ensure patient safety and use sound clinical judgment in consideration of whether to treat in the water or at poolside. Also, be aware, individual payers may have their own requirements for aquatic therapy services and therapists should check each individual's policy before commencing services. If therapists are not treating in the water, it may be more difficult to justify and support the medical necessity for skilled intervention.

The Centers for Medicare and Medicaid Services lists specific language outlining the requirements for consideration of reimbursement for beneficiaries. The detailed information can be found at: http://www.cms.gov/Regulations-and- Guidance/Guidance/Manuals/downloads/bp102c15.pdf. (Rev. 194; 09-03-2014). One of the most important considerations is establishing the medical necessity of services and supporting the provision of skilled need.

Aquatic physical therapy sessions must be performed and supervised by a licensed physical therapist or physical therapist assistant. Technicians, athletic trainers, exercise physiologists, kinesiotherapists, etc. are not eligible to perform or bill for aquatic physical therapy services.

Research shows most aquatic therapy is performed in pools with temperatures ranging from 82-92 degrees. The temperature is highly variable depending upon the type of activity performed. Water temperatures for passive activity such as Watsu may be higher (90+ degrees) whereas the temperature needed for patients to perform aerobic exercises is 82-88 degrees). Special consideration should be given to some patient populations and diagnoses such as multiple sclerosis, given that some populations may have sensitivity to heat requiring lower temperatures.

There is presently no legal or professional requirement for a therapist to be certified or credentialed to perform aquatic physical therapy. However, it is critical to the profession for therapists to become knowledgeable in the specifics of aquatic physical therapy to provide safe and clinically relevant treatment.

The APTA Academy of Aquatic Physical Therapy offers a clinical competency certificate. The program consists of a series of online modules followed by a 3-day in-person pool course offered at various locations 3 times per year. You can find out more and register by visiting the academy's learning center.

The academy offers a variety of recorded webinars and in-person educational opportunities. Additionally, the Journal of Aquatic Physical Therapy is the academy's publication offering relevant, peer-reviewed research and topics of interest related to aquatic physical therapy.

The APTA Academy of Aquatic Physical Therapy is always looking to engage members in committees or on the Board of Directors. If you are curious, don't be shy! We'd love to talk to you. We believe in finding an opportunity that is of interest to you, not arduous! Just send the a quick email to admin@aquaticpt.org and we'll be in touch soon!