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Hydrotherapy refers to the use of water in the treatment of disease or trauma. The patient lies on the surface of a hydrotherapy table completely clothed. A mattress filled with heated water is under the surface of the table. A pump propels the water toward the patient through hydro-jets. The pressure of the water against the patient’s body provides the massage. The therapy can be applied to nearly every part of the body simply by changing the patient’s position. This is unattended hands-free massage.

Dry hydromassage is considered investigational.

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Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

1/21/2004: Code Reference section completed

10/13/2006: Policy reviewed, no changes

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