Question
How can therapists effectively justify the use of aquatic therapy for insurance reimbursement?
Answer
To secure insurance reimbursement for aquatic therapy, therapists must provide clear, evidence-based justification that highlights its medical necessity. Many payers require documentation that demonstrates why aquatic therapy is superior to land-based treatment for a specific patient. This can include references to systematic reviews and meta-analyses that support aquatic therapy for multiple sclerosis, particularly its benefits in improving fatigue, balance, and motor function. Therapists should explicitly state how water-based treatment provides a safer environment for balance training, reduces fall risk, and minimizes joint stress while enhancing strength and endurance.
Additionally, therapists should document measurable functional improvements observed in the pool and on land. Insurance companies often require proof of carryover effects, meaning patients must demonstrate progress in land-based functional tasks as a result of their aquatic therapy. Using objective assessments such as the Berg Balance Scale or gait analysis can help justify continued treatment. Therapists should also be prepared to navigate restrictions, such as limits on the number of aquatic therapy sessions, and proactively seek prior authorization when needed. By using precise, outcome-driven language in their documentation, therapists can improve their chances of obtaining coverage for aquatic therapy services.
This Ask the Expert is an edited excerpt from the course, "Aquatic Therapy for the OT and PT: Emphasis on Multiple Sclerosis," presented by Andrea Salzman, MS, PT.
