Aetna FAQ for Outpatient Therapy Services

Aetna FAQ for Outpatient Therapy Services

This Aetna FAQ, based on guidance from Gawenda Seminars & Consulting, addresses common questions regarding outpatient physical therapy, occupational therapy, and speech therapy services. It explains whether a physician order and a signed, dated plan of care are required, whether Aetna follows Medicare’s 8-minute rule, and which interventions, procedures, and services Aetna considers experimental, investigational, or unproven.

Does Aetna require a physician order to begin outpatient physical therapy? No. Effective October 29, 2025, Aetna no longer requires a physician order for members to begin outpatient physical therapy.

What is required in a physical therapy plan of care? Aetna requires the following elements in a physical therapy plan of care:

Diagnosis Date of onset Reasonable estimate of when goals will be achieved Frequency and duration of treatment Long-term and short-term goals that are specific, measurable, and objective Specific treatment techniques and/or exercises to be used Signature of the physical therapist who established the plan of care

Does Aetna require a physician to sign and date an outpatient physical therapy plan of care? No. Effective October 29, 2025, Aetna does not require a physician signature or date on the outpatient physical therapy plan of care.

Does Aetna require a physician order to begin outpatient occupational therapy? Yes. Aetna requires outpatient occupational therapy services to be ordered by a physician or another licensed healthcare practitioner.

What is required in an occupational therapy plan of care? Aetna requires the following:

Diagnosis Date of onset Quantitative objectives Reasonable estimate of when goals will be achieved Frequency and duration of treatment Specific statements of long-term and short-term goals Specific treatment techniques and/or exercises to be used Signature of the occupational therapist who established the plan of care Signature of the attending physician

Does Aetna require a physician to sign and date an outpatient occupational therapy plan of care? Yes. Aetna requires both the occupational therapist and the attending physician to sign and date the occupational therapy plan of care.

Does Aetna require a physician order to begin outpatient speech therapy? No. According to Aetna’s Speech Therapy Clinical Policy Bulletin, outpatient speech therapy services do not need to be ordered by a physician or other licensed healthcare practitioner.

What is required in a speech therapy plan of care? Aetna requires the following:

Speech therapy evaluation Diagnosis Date of onset or exacerbation Frequency and duration of treatment Long-term and short-term goals that are specific, measurable, and objective Reasonable estimate of when goals will be achieved Specific treatment techniques and/or exercises to be used Signature of the speech-language pathologist who established the plan of care Signature of the attending physician

Does Aetna require a physician to sign and date an outpatient speech therapy plan of care? Yes. Aetna requires both the speech-language pathologist and the attending physician to sign and date the speech therapy plan of care.

Does Aetna follow Medicare’s 8-minute rule? Aetna’s published clinical policies and related resources do not directly reference the use of Medicare’s 8-minute rule. Providers should review their contracts for any applicable billing language related to outpatient therapy services.

Does Aetna cover outpatient physical or occupational therapy for return-to-sport activities? No. Aetna states that sports-related rehabilitation and similar avocational activities are not covered because they are not considered treatment of disease. This includes activities related to sports such as baseball, cheerleading, golf, martial arts, football, basketball, soccer, lacrosse, swimming, track and field, tennis, dance, weightlifting, and similar pursuits in school, community, amateur, or professional settings.

Does Aetna cover blood flow restriction therapy? No. Aetna considers blood flow restriction therapy experimental, investigational, or unproven.

Does Aetna cover virtual reality–facilitated gait training? No. Aetna considers virtual reality–facilitated gait training experimental, investigational, or unproven.

Does Aetna cover driver training? No. According to Aetna’s Occupational Therapy Clinical Policy Bulletin, driver training is not considered treatment of disease because driving is not viewed as a basic activity of daily living.

Does Aetna reimburse for aquatic therapy? Yes. Aetna considers aquatic therapy medically necessary for musculoskeletal conditions.

Does Aetna reimburse for behavioral vision therapy or vision restoration therapy? No. Aetna considers these services experimental, investigational, or unproven.

Aetna specifically states:

Behavioral vision therapy, also known as visual perceptual training, is considered experimental, investigational, or unproven for visual perceptual dysfunctions and all other indications because its effectiveness has not been validated in well-designed prospective clinical studies. Vision restoration therapy is considered experimental, investigational, or unproven for visual field deficits due to ischemic optic neuropathy, neurotrauma, stroke, and all other indications because its effectiveness has not been established. Vision restoration therapy, whether used alone or combined with transcranial direct current stimulation, is also considered experimental, investigational, or unproven for visual field deficits following stroke or neurotrauma because its clinical value has not been established.

What speech therapy services does Aetna consider experimental, investigational, or unproven? According to Aetna’s Speech Therapy Clinical Policy, examples include:

Altered auditory feedback devices for stuttering and all other indications Facilitated communication for all indications Orton-Gillingham approach for speech therapy Speech therapy as treatment for chronic cough Speech therapy for post-extubation dysphonia following COVID-19 hospitalization Transcutaneous electrical nerve stimulation used in speech therapy rehabilitation of voice and swallowing

Where can providers access Aetna policies relevant to outpatient therapy services? Providers may access Aetna’s clinical policies related to outpatient therapy services through the appropriate Aetna policy resources.