Finding out why your local Medicare office might deny aquatic therapy

Did you know Medicare will only pay for 12 sessions of aquatic therapy? Or that you must "try and fail" at land-based therapy before putting your patient into the pool? Or that you cannot see your patient on land and in the pool during the same treatment bout?

These -- and other untruths and misconceptions -- are running rampant in the industry. Why?

Even though Medicare is a federal program, CMS leaves many reimbursement decisions up to local contractors.

This means that although "aquatic therapy" (CPT code 97113) is considered a covered service under Medicare, your local contractor may restrict its use or deny coverage unless you meet certain standards. And some local contractors do have restrictions like those listed above.

This is frustrating as heck -- and many practitioners get caught with their pants down (financially speaking) when billing for aquatic therapy.

But, there is a single "go to" source to find out exactly what your local Medicare contractor has to say about "aquatic therapy" in its LCDs (Local Coverage Documents).

Here's how to find the LCDs for your Medicare contractor:

1. Do you already know the name of your local carrier or intermediary? Then skip this step. Otherwise, find out the name of your local Medicare A or B contractor here.

2. Once you know who your local contractor is (for Medicare Part A or B), you will want to read their LCDs about aquatic therapy. Log onto this page to start. A search page will pop up.

Step 1: Click "Local Coverage" and some drop-down presets will load. Change the Articles preset to "Key Articles Only".

Step 2: Enter your state or geographic area -- or, if you already know it, enter the name of your contractor (carrier or intermediary).  Then, select the box under "Pick one or more" which says CPT/HCPCS. Enter "97113" in the search box. Click "Search now".

Articles specific to your state or your local contractor will come up. Click on each article's hyperlink to open the article. Once the article is open, perform a search for the term "97113" inside the article and read what your contractor has to say about aquatic therapy.

Comments

[Carrie Schwartz]

Can you bill the aquatic code if the facility that you are currently using isn't yours?