Aquatic therapy is an essential rehabilitative service for individuals recovering from catastrophic injuries, including those covered under Michigan’s Personal Injury Protection (PIP) No-Fault Insurance system. However, proper CPT Code usage and provider qualifications are critical to ensuring compliance with MCL 500.3157, which governs the legitimacy of reimbursable medical expenses.
CPT Codes and Licensed Providers
When billing for aquatic therapy under physical therapy CPT codes, such as:
- 97113 – Aquatic therapy with therapeutic exercises
- 97110 – Therapeutic exercises performed in water to improve strength, endurance, range of motion, or flexibility
a licensed physical therapist (PT) or a certified physical therapist assistant (PTA) under direct supervision must render the services. The Michigan No-Fault system does not reimburse these CPT codes if the services are provided solely by an athletic trainer, personal trainer, or unlicensed therapy aide, as they are not recognized as qualified medical professionals under MCL 500.3107(1)(a) for rehabilitation reimbursement.
Why Athletic and Personal Trainers Are Not Covered While athletic trainers and personal trainers play valuable roles in fitness and injury prevention, they are not licensed medical professionals under Michigan’s Public Health Code (MCL 333.17801 et seq.) governing physical therapy. Because of this, their services cannot be billed under physical therapy CPT codes within the Michigan PIP system.
According to MCL 500.3157(1), for treatment to be reimbursed, it must be lawfully rendered by a licensed provider within the scope of their professional practice. Athletic trainers and personal trainers lack the credentials to legally provide physical therapy interventions, including aquatic therapy under CPT 97113. If an insurer finds that an unqualified individual rendered the service, it may reject or dispute the claim, leading to non-payment.
Compliance and Reimbursement Under Michigan No-Fault
To ensure proper reimbursement, providers must:
- Ensure only licensed PTs or certified PTAs deliver and supervise aquatic therapy sessions.
- Clearly document the provider’s credentials in the patient’s medical record.
- Use the correct CPT Code and ensure services are medically necessary per MCL 500.3107(1)(a).
Failing to meet these standards can lead to denied claims, audits, and potential fraud investigations. To protect both patients and providers, Michigan PIP No-Fault insurers are required to pay only for properly administered and documented medical rehabilitation services.
Disclaimer:
This trade article from Electronic Medical Services is for informational purposes only and should not be considered legal, financial, or medical advice. The content is based on current industry practices and regulations, which are subject to change without notice. Readers are encouraged to verify any information with relevant regulatory authorities, legal counsel, or professional advisors before making decisions based on this article. Electronic Medical Services assumes no liability for errors, omissions, or any outcomes resulting from the use of this information.
Another Blog Post by Direct Care Training & Resource Center, Inc. Photos used are designed to complement the written content. They do not imply a relationship with or endorsement by any individual nor entity and may belong to their respective copyright holders.
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