Non-Covered Services & Self-Pay Options

Some physical therapy treatments, while beneficial, are not covered by Aetna due to a lack of sufficient clinical evidence or because they do not meet the insurer’s definition of medical necessity. These include:

• Virtual Reality (VR) Facilitated Gait Training – Uses VR technology for balance and gait rehabilitation but has limited evidence of long-term effectiveness.

• Kinesio Taping, McConnell Taping, and General Taping – Elastic or rigid taping methods meant to support muscles and joints. Studies do not show significant improvements in function, strength, or pain relief.

• MEDEK Therapy – A pediatric therapy used to improve gross motor skills, especially in children with neurological conditions. Lacks peer-reviewed research confirming effectiveness.

• Hands-Free Ultrasound – A non-contact ultrasound device that does not generate the same level of deep tissue heating as manual ultrasound.

• Hivamat Therapy (Deep Oscillation Therapy) – Uses electrostatic waves for deep tissue massage, but clinical studies supporting its effectiveness are limited.

• Applied Functional Science – A movement-based therapy combining biomechanics and rehabilitation, but there is no peer-reviewed research proving its effectiveness.

• McKenzie Method – A self-directed therapy approach for spinal and extremity pain. Shows limited short-term benefits but no significant long-term advantages over standard treatments.

• Myofascial Physical Therapy for Chronic Pelvic Pain – Manual therapy targeting pelvic floor muscles. While some early studies suggest benefits, there is not enough large-scale evidence for insurance coverage.

• Blood Flow Restriction Therapy (BFRT) – Uses pneumatic cuffs to restrict blood flow during exercise, which may enhance muscle strength. However, safety standards and research findings are inconsistent.

• RomTech PortableConnect – A home-based physical therapy device for clinician-controlled rehab sessions. No published studies confirm its effectiveness.

All of the above services can be added to your physical therapy session for $40 per service if you choose to proceed with self-pay.

Duplicative & Non-Medically Necessary Services

Aetna also restricts coverage for services that are considered duplicative or not medically necessary. These include:

• Functional Activities & ADL Training – Exercises aimed at improving daily tasks such as dressing, cooking, or getting in and out of bed. These services cannot be billed together in the same session.

• Infrared Therapy & Ultraviolet Therapy – Both are light-based therapies used for pain relief and circulation. Insurance does not cover them when performed in the same session.

• Massage Therapy & Myofascial Release – Hands-on techniques to release muscle tension and improve mobility. Insurance only covers one type of soft tissue work per session.

• Microwave Therapy & Infrared Therapy – Heat-based pain relief therapies that cannot be billed together. Only one heat modality is allowed per session.

• Orthotic Training & Prosthetic Training – Training to use braces (orthotics) or artificial limbs (prosthetics). These services are not covered if performed together in one session.

• Whirlpool Therapy & Hubbard Tank Therapy – Water-based treatments for pain and mobility. Insurance does not allow both to be billed in the same session.

• Strapping & Taping for Non-Covered Conditions – Includes taping for general musculoskeletal conditions, hip pain, or ankle stress fractures. These are not covered except in very limited cases.

• Routine Maintenance Therapy – Passive stretching, range of motion, or general conditioning exercises that do not show measurable progress.

• Prolonged Massage Therapy – Insurance does not cover extended massage therapy beyond the acute healing phase.

• Multiple Heat Modalities in One Session – Only one type of heat therapy (e.g., hot packs, infrared therapy) can be covered per session.

• Sports-Specific Rehabilitation – Training to improve athletic performance, such as agility drills or pitching mechanics, is not covered unless deemed medically necessary for injury recovery.

• Non-Medically Necessary Home PT – Therapy provided at home for convenience rather than necessity. Insurance only covers this if the patient is homebound.

Final Takeaways

• These restrictions are set by Aetna, not by our clinic.

• You can choose to add any non-covered service for $40 per service.

• Only one heat-based therapy is allowed per session.

• Duplicative services cannot be billed together in the same session.

• All services must meet medical necessity standards, including documented progress and clear functional goals.

What Does "Medical Necessity" Mean?

Insurance companies define medical necessity as treatment that is essential for a patient’s health. To be considered medically necessary, a service must:

✔ Address a specific medical condition, injury, or functional limitation.
✔ Be proven effective through research and clinical guidelines.
✔ Require the expertise of a licensed physical therapist—not something you could safely do on your own.
✔ Have clear, measurable goals for improvement.
✔ Show progress over time. If a service is not leading to functional improvements, insurance may consider it unnecessary.

For example, physical therapy to help you regain the ability to walk after surgery is medically necessary. However, treatments focused on general wellness, relaxation, or injury prevention—such as taping or deep tissue massage—may not be covered.

If you have questions about your coverage, we recommend reaching out to Aetna directly for details about your specific plan.