CPT code 97113
CPT code 97113 is the procedure code for aquatic therapy with therapeutic exercises to one or more body areas for one unit every 15 minutes. Occupational therapists utilize the benefits of water to perform exercises that may be difficult for clients to complete on land, aiming to improve overall daily functioning for meaningful activities such as ADLs. This article will discuss specifics and considerations for optimizing CPT code 97113 in your therapy practice.
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What is CPT code 97113?
CPT code 97113 defined by the American Medical Association, is when a provider instructs or supervises a client to perform therapeutic exercises in the water. Types of procedures covered under this code include exercises for strength, endurance, or arm exercises using water weights. The zero-gravity effect of water also allows the therapist to utilize postures and positioning that may otherwise be difficult to achieve on land due to medical complexity or movement limitations.
Aquatic therapy is a timed code, following the 8-minute rule, billed every 15 minutes. Medical necessity and coverage criteria for using CPT code 97113 include documenting the client’s condition with an accompanying joint motion restriction or loss of strength, mobility, or function that will benefit from the therapeutic benefit of water, such as buoyancy or resistance to meet goals reported in a treatment plan.
Documentation requirements
Standard documentation requirements apply including documentation of start and end times, and signature of the supervising therapist should be included in your notes for each date of service.
Additional requirements include:
- Clearly justifying the need for aquatic therapy exercises beyond 8 visits.
- Justifying the need for performing exercises in an aquatic environment.
- Documenting pain rating before and after treatment, the location of pain and effect on function.
- Including objective measurements for loss of strength, mobility, decreased ADLs, balance, coordination and posture and its effect of function.
- Specific exercises performed, including progression of the exercises, purpose of exercises, and relation to function.
- Documenting clinical skills required such as instructions given, and/or assistance needed to perform exercises.
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CPT code 97113 and occupational therapy
Occupational therapy services covered by CPT code 97113 include therapeutic exercises, therapeutic activities, neuromuscular reeducation, or gait activity performed in the water, including pools, Hubbard tanks, whirlpools, and underwater treadmills.
Treatment modalities are typically not charged in addition to aquatic therapy during direct treatment time requiring clinical skill. CPT code 97113 fits into occupational therapy treatment plans to utilize the therapeutic benefits of water to achieve activities, motions, and exercises that may be difficult to perform on land.
Maximizing reimbursement for CPT code 97113
Common reimbursement issues for CPT code 97113 and other codes include incomplete documentation, not documenting a clear link for how aquatic activities will benefit clients in meeting their treatment goals or missing objective measures to record progress. Justification for using the aquatic therapy code is required to support how activities and exercises performed in the water are necessary for helping the client meet their treatment goals.
Coding and billing tips for CPT Code 97113
- Centers for Medicare and Medicaid Services (CMS) will not reimburse for aquatic therapy if no exercises are being performed in situations such as ulcer debridement. Ensure treatment criteria is met when selecting respective codes by reviewing guidelines published on the CMS website.
- Group Therapy, CPT® code 97150 is used when the therapist is treating more than one client at the same time in the aquatic environment. The group therapy code, procedure 97150 would be used instead of aquatic therapy, 97113.
- Treatment time only counts toward activities where skilled exercises or activities are being performed requiring direct one-on-one direct care from a qualified healthcare professional. Time where a client is dressing, undressing, or transferring into/out of an aquatic environment does not count toward billable treatment time for CPT code 97113.
Key documentation elements for reimbursement success
- Justify why an aquatic environment is necessary for a client to perform exercises and activities to meet their goals.
- Include initial and frequent objective measures to record how the client is progressing with aquatic therapy participation in meeting their treatment goals.
- Document a clear link to how specific aquatic therapy activities will meet specific treatment plan goals for helping increase a client’s independence and participation in daily tasks.
- Document diagnosis requiring skilled therapy and skilled procedures performed in aquatic environments to justify medical necessity.
- Be sure to include specifics in documentation such as specific exercises, location (Right arm, shoulder, hand, etc.), and direct skilled treatment time.
CPT code 97113 and compliance
The aquatic therapy procedure CPT code 97113 requires supervision or assistance from a qualified healthcare provider while a client performs exercises or skilled activities in the water. A modifier may also be required depending on your specific insurance payor guidelines. Check with your respective insurance providers and CMS resources for additional restrictions or modifiers required.
Potential compliance risks include incomplete documentation, incorrect coding, or errors with units charged per treatment time recorded. Incomplete documentation, such as not documenting client progress and how the service has adapted to accompany frequent billing of the same code to justify repetitive charges to reduce your risk of a denial. Strategies to ensure compliance include keeping up to date with CMS regulations and updates from insurance payors to meet standards for documentation and billing. Most insurance payors have a representative or method of contact you can use to ensure you are meeting compliance standards for your therapy practice.
CPT code 97113 is used for aquatic therapy when a therapy utilizes the therapeutic benefits of water to help clients perform exercises and activities that may be difficult on land. This treatment is beneficial and considered medically necessary to help ease a client’s symptoms such as pain management, and address a loss of function, decreased strength, motion restriction, or mobility limitation resulting from functional decline from a disease, natural aging process, or specific condition. Aquatic therapy exercises and activities provide a supportive environment for practicing tasks such as carrying and reaching for ADLs, making it a beneficial component of any occupational therapy treatment plan.
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How EHR and practice management software can save occupational therapists time on insurance billing
EHR with integrated billing software and a clearing house, such as TheraPlatform, offers occupational therapists significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.
Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save OT providers time when it comes to insurance billing for therapists.
Resources
TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports different industries and sizes of practices, including occupational therapists in group and solo practices.
More resources
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
- Insurance billing 101
- Practice management tools
