Dec '25 • General discussion
Aetna Updates 2025/2026
Aetna implemented several PT-friendly policy changes in late 2025 that carry into 2026. In an update effective Oct 29, 2025, Aetna revised its Physical Therapy Clinical Policy Bulletin to better reflect modern PT practiceapta.orgapta.org. Key improvements include:
- Recognition of Telehealth: Aetna’s policy now explicitly states that physical therapy may be delivered via telehealth platforms as appropriateapta.org. This indicates Aetna supports virtual PT sessions (for example, video-based therapy exercises or evaluations) as part of its covered services. (Aetna had covered telehealth broadly during the pandemic; this policy update cements tele-PT as acceptable when medically necessary.) Providers should still verify that a given Aetna plan has telehealth benefits, but in general Aetna plans in 2026 do reimburse telehealth PT similar to in-person, often requiring POS 02/10 and modifier 95. Many Aetna plans use Teladoc or similar networks for virtual care, but members can also use their regular PT via telehealth if allowed by state law and plan coverage.
- Direct Access and Referrals: In mid-2025 Aetna removed referral requirements to align with unrestricted direct access to PT. This was a major advocacy win – over 26 million Aetna-covered Americans now have the option to go directly to a physical therapist without a physician prescriptionapta.org. Practically, this means Aetna no longer denies claims for “no referral” if the state practice act permits direct access. (Patients can self-refer to PT and Aetna will cover it, whereas previously some Aetna HMO products required a script or prior auth from an MD.) This change simplifies the start of care: therapists can evaluate and treat Aetna patients promptly.
- Home-Based Therapy: Aetna’s updated policy removed the requirement that a patient be homebound to receive home-based PTapta.org. Earlier, Aetna would only cover in-home PT (outside of a home health episode) if the patient was essentially unable to leave home. Now, if Aetna members choose to have a therapist come to their home for outpatient therapy (say via companies that provide home visits, or newer models like Luna physical therapy), Aetna can cover it, subject to plan benefits, even if the patient isn’t strictly homebound. This gives more flexibility for patients who have transportation issues but don’t meet Medicare’s home health criteria.
- Assistant Supervision and Other Clarifications: Aetna updated its PTA supervision language, dropping any stricter “direct supervision” wording and deferring to state law/Medicare rules (meaning general supervision of PTAs is acceptable in outpatient settings)apta.org. They also expanded definitions of certain modalities: for example, gait training, neuromuscular re-education, and therapeutic exercise descriptions were broadened to acknowledge their multiple benefits without implying arbitrary limits on number of visitsapta.org. These adjustments in documentation terminology mean Aetna’s reviewers should be less likely to deny claims based on outdated notions (like expecting a “standard” episode of X visits for an intervention).
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Aetna Updates 2025/2026
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