As with all Medicare services, aquatic therapy must be medically reasonable and necessary in order for the provider to receive payment. Here are some of the most common reasons intermediares such as Cigna are choosing to deny aquatic therapy.
- Therapy services were provided to beneficiaries with no identified need for the use of this type of therapy. There was little evidence to support the need for use of a water based environment (i.e. buoyancy for un-weighting joints, resistance, and/or loss of motion).
- Services were provided for excessive durations of time per treatment session. In some cases aquatic therapy was rendered in excess of one hour.
- Aquatic therapy services continued for long periods of time (several months) in the absence of documented functional gains.
- Services were repetitive in nature and appeared to be for conditioning and overall fitness or maintenance.
- There was little evidence of transitioning the aquatic exercise program to a land-based exercise program to improve functional performance with every day activities.
- The programs provided in the pool setting were rendered in a group environment yet individual therapy was billed.
(Editor's Note: I would argue that the first reason is absurd. As long as equivalent or better results have been shown for working in water (and the research is mounting!), there should be no reason to have to forgo the pool for land. If the argument is that working in an "aquatic environment" is not functional, then I'd like to see the payer explain why they willingly reimburse for spinal traction or unweighted treadmill work).