Aetna modified CPB 0699 covering dry hydrotherapy (hydromassage, aquamassage, water massage), effective October 16, 2025. Here's what billing teams need to know.
Aetna, a CVS Health company, updated Clinical Policy Bulletin CPB 0699 to reaffirm its position: dry hydrotherapy is experimental, investigational, or unproven across all indications. This coverage policy applies to CPT codes 97010, 97022, and 97124, along with HCPCS codes G0151 and S9131. If your team bills any of these codes for Aetna members and the service involves dry hydrotherapy, hydromassage, or aquamassage, expect denial.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Dry Hydrotherapy (Hydromassage, Aquamassage, Water Massage) |
| Policy Code | CPB 0699 |
| Change Type | Modified |
| Effective Date | October 16, 2025 |
| Impact Level | Medium |
| Specialties Affected | Physical therapy, occupational therapy, chiropractic, ophthalmology, integrative medicine |
| Key Action | Audit any claims billing CPT 97010, 97022, or 97124 for dry hydrotherapy services and stop submitting them as covered under Aetna |
Aetna Dry Hydrotherapy Coverage Criteria and Medical Necessity Requirements 2025
The Aetna dry hydrotherapy coverage policy is straightforward: there are no covered indications. Aetna does not recognize dry hydrotherapy as medically necessary for any condition. The basis for this position is a lack of sufficient scientific evidence establishing clinical effectiveness.
This matters because CPT codes like 97022 (whirlpool) and 97124 (massage) get used broadly across physical therapy and rehabilitation billing. Those codes can support legitimate covered services in other contexts. The problem comes when the underlying service is a dry hydrotherapy device — a hydromassage table, aquamassage pod, or similar equipment — rather than conventional therapeutic massage or whirlpool treatment.
Aetna's distinction here is about the modality, not the CPT code. The same CPT 97124 that passes through fine for a hands-on therapeutic massage will get denied if the documentation shows the service was delivered via a hydromassage table. Your medical necessity documentation needs to be clear about the actual modality used.
There is no prior authorization pathway that unlocks coverage for dry hydrotherapy under this policy. Prior authorization won't help here — the service is categorically non-covered. Don't send prior auth requests expecting approval. The answer will be no.
Aetna Dry Hydrotherapy Exclusions and Non-Covered Indications
Aetna's CPB 0699 covers two specific non-coverage designations. Both are classified as experimental, investigational, or unproven.
First: Dry hydrotherapy in all its forms — hydromassage, aquamassage, water massage — is non-covered for any indication. Aetna's position is that the evidence base is insufficient to support reimbursement.
Second: Hydromassage of macular hole edges for full-thickness macular holes is separately called out as experimental. This is an ophthalmology-specific application. ICD-10 codes H35.341 through H35.349 (macular cyst, hole, or pseudohole) are explicitly listed as diagnoses not covered under this policy. If you're billing ophthalmology claims with these diagnosis codes and any massage-related procedure code, that combination will not pass Aetna's coverage review.
The ophthalmology exclusion is worth flagging separately. It's unusual to see a massage-related policy explicitly reference macular hole treatment. This suggests Aetna has seen claims attempting to use dry hydrotherapy in surgical ophthalmology contexts — possibly intraoperative or adjunctive procedures. If your practice performs any procedures involving macular hole treatment and you've been using hydromassage as an adjunct, stop billing that to Aetna.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Dry hydrotherapy (all indications) | Experimental / Not Covered | CPT 97010, 97022, 97124; HCPCS G0151, S9131 | No covered pathway; prior auth does not apply |
| Hydromassage of macular hole edges for full-thickness macular holes | Experimental / Not Covered | ICD-10 H35.341–H35.349 | Ophthalmology-specific; diagnoses explicitly excluded |
Aetna Dry Hydrotherapy Billing Guidelines and Action Items 2025
This policy is not new — CPB 0699 has existed for some time. But modifications mean the policy was reviewed and updated as of October 16, 2025. Aetna reaffirmed its non-coverage position. That makes this the right moment to clean up your charge capture and documentation practices before claims pile up.
Here are the specific actions your billing team should take:
| # | Action Item |
|---|---|
| 1 | Audit your charge master for CPT 97010, 97022, and 97124. Check whether any of these codes are mapped to dry hydrotherapy devices, hydromassage tables, or aquamassage equipment in your facility. If they are, flag those entries for review. The codes themselves aren't non-covered — their use for dry hydrotherapy specifically is what triggers denial. |
| 2 | Pull a 90-day lookback on Aetna claims using CPT 97022 and 97124. Look for any claims where the service notes reference hydromassage, aquamassage, or automated water massage equipment. If those claims were submitted to Aetna and approved, they may be vulnerable to audit and recoupment. Talk to your compliance officer before the end of 2025 if you find a pattern. |
| 3 | Update your clinical documentation templates before October 16, 2025. Therapists and providers documenting these services need to clearly identify the treatment modality. "Therapeutic massage, manual, effleurage and petrissage techniques applied by therapist" is a very different claim from "patient placed on hydromassage table for 15 minutes." The modality drives coverage. Documentation needs to reflect the actual service. |
| 4 | Alert your ophthalmology billing team about the macular hole exclusion. If your organization has ophthalmology providers, make sure they know that H35.341 through H35.349 are explicitly excluded diagnoses under this policy for any hydromassage-related billing. This is a niche scenario, but claim denial based on this combination is a real risk. |
| 5 | Do not attempt prior authorization for dry hydrotherapy services. There is no medical necessity pathway that opens coverage here. Submitting a prior auth request for a categorically excluded service wastes time and may create documentation in the member's file. Redirect patients to covered alternatives — aquatic therapy under CPB 0174 (pool therapy) may be an option worth exploring for appropriate clinical cases. |
| 6 | Review your HCPCS G0151 and S9131 usage in home health and hospice settings. G0151 covers qualified physical therapist services in home health or hospice. S9131 covers home physical therapy per diem. If your home health agency or hospice program uses hydromassage equipment as part of therapy delivery, those claims will not pass Aetna's coverage review under CPB 0699. The modality restriction applies in those settings too. |
If you're running a high volume of wellness, chiropractic, or integrative medicine services and you have hydromassage equipment on-site, this policy change has real financial exposure. Talk to your compliance officer about how this applies to your specific payer mix and service lines.
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Dry Hydrotherapy Under CPB 0699
CPT Codes Related to This Policy
These codes appear in CPB 0699 as related codes. They are not inherently non-covered — but billing them for dry hydrotherapy services specifically will result in claim denial under this policy.
| Code | Type | Description |
|---|---|---|
| 97010 | CPT | Application of a modality to one or more areas; hot or cold packs |
| 97022 | CPT | Application of a modality to one or more areas; whirlpool |
| 97124 | CPT | Therapeutic procedure, one or more areas, each 15 minutes; massage, including effleurage, petrissage |
HCPCS Codes Related to This Policy
| Code | Type | Description |
|---|---|---|
| G0151 | HCPCS | Services performed by a qualified physical therapist in the home health or hospice setting, each 15 minutes |
| S9131 | HCPCS | Physical therapy; in the home, per diem |
ICD-10 Diagnosis Codes Explicitly Not Covered Under CPB 0699
These diagnosis codes are listed as not covered for indications described in this policy. Claims combining these codes with hydromassage-related procedures will not pass Aetna's coverage review.
| Code | Description |
|---|---|
| H35.341–H35.349 | Macular cyst, hole, or pseudohole |
A Note on Related Coverage Policies
Aetna's CPB 0699 is specifically about dry hydrotherapy — the kind delivered by machines, without water contact. It is not the same as pool therapy, aquatic therapy, or conventional hydrotherapy.
If a patient's clinical picture supports aquatic or pool therapy, that's governed by Aetna CPB 0174 (Pool Therapy, Aquatic Therapy or Hydrotherapy). That's a separate coverage policy with its own criteria. Some services that fail under CPB 0699 may qualify under CPB 0174 — but you can't assume. Review CPB 0174 separately to determine whether the patient's condition meets those specific medical necessity criteria.
The distinction matters for patient communication too. If a provider wants to recommend water-based therapy and the patient has Aetna coverage, make sure you're directing them to the right service with the right billing documentation from the start.
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