Aetna physical therapy coverage: codes, limits and who can bill
The short answerAetna covers PT that is medically necessary under CPB 0325: a licensed PT, a written plan of care, and expected significant improvement within about a month (or setting up a maintenance program). Aetna HMO plans typically limit PT to a 60-day treatment period per condition.
By Javier Alvarez · Updated · 1 min read
1 row: Aetna. Public policy, not the member's benefits.
Aetna
Aetna Clinical Policy Bulletin 0325, Physical Therapy (last review 06/02/2026) · All states
| 97110 | Listed (covered if the CPB 0325 criteria are met) [1] |
|---|---|
| 97112 | Listed (covered if the CPB 0325 criteria are met) [1] |
| 97140 | Listed (covered if the CPB 0325 criteria are met) [1] |
| 97161 | Listed (97161 to 97164 evaluation and re-evaluation, covered if criteria are met) [1] |
| 97530 | Listed (covered if the CPB 0325 criteria are met) [1] |
| Where it applies | Aetna considers PT medically necessary to significantly improve, develop or restore functions lost or impaired by disease, injury or surgery, when the practitioner expects significant improvement within one month or a safe maintenance program can be set up. Services must be done by a licensed PT, or under supervision where state law allows, and follow a written plan of care. [1] |
| Other codes | The covered-code table also lists 97116 gait training, 97535 self-care training, 97537 community reintegration training, 97542 wheelchair management and 97760 to 97763 orthotic and prosthetic codes. [1] |
| Visit limits | Typically, in Aetna HMO plans the PT benefit is limited to a 60-day treatment period per condition (calendar year, contract year or lifetime, depending on the plan); a new condition, such as surgery, can start a new 60-day course. In HMO, QPOS, Health Network Only and Health Network Option plans, short-term home-based PT also counts toward the 60-day limit or other rehab benefit limits. [1] |
| Who can bill | Services must be performed by a duly licensed (and certified, if applicable) PT within scope of practice. Physicians cannot directly supervise physical therapy assistants because they are not licensed as physical therapists. [1] |
| Also | Not medically necessary: PT in asymptomatic people, PT when the condition is neither regressing nor improving, and supervised PT once the benefit is reached or a home exercise program would do. Documentation: diagnosis with onset date, goals, evaluation, frequency and duration, techniques, PT signature, and re-evaluation at least monthly. [1] |
- Aetna: Clinical Policy Bulletin 0325, Physical Therapy (last review 06/02/2026), checked October 30, 2026
What Aetna's documents say
The table above has every field we found for Aetna, with numbered sources. In short:
- Visit limits. Typically, in Aetna HMO plans the PT benefit is limited to a 60-day treatment period per condition (calendar year, contract year or lifetime, depending on the plan); a new condition, such as surgery, can start a new 60-day course. In HMO, QPOS, Health Network Only and Health Network Option plans, short-term home-based PT also counts toward the 60-day limit or other rehab benefit limits.
- Who can bill. Services must be performed by a duly licensed (and certified, if applicable) PT within scope of practice. Physicians cannot directly supervise physical therapy assistants because they are not licensed as physical therapists.
- Where it applies. Aetna considers PT medically necessary to significantly improve, develop or restore functions lost or impaired by disease, injury or surgery, when the practitioner expects significant improvement within one month or a safe maintenance program can be set up. Services must be done by a licensed PT, or under supervision where state law allows, and follow a written plan of care.
- Codes. 97110, 97112, 97140, 97161 and 97530 are listed.
Physical therapy coverage at other national payers
Medicare, UnitedHealthcare Medicare Advantage, UnitedHealthcare Commercial, Cigna, Humana and TRICARE.
Check Aetna's claim against the row
Before the claim goes out, compare it with the row above: the evaluation code matches the complexity you documented, the timed codes fit the minutes, any prior authorization covers the visit, and the plan of care is signed when the payer asks for it. The physical therapy table compares Aetna with every other payer we checked.