Where is aquatic therapy billed most? Medicare CPT® 97113 by state, 2024
Aquatic therapy through statistics · Aquatic Therapy by the Map: all maps
This map shows how often aquatic therapy billed as CPT® 97113 was paid for by Original Medicare (Part B fee-for-service) in each state in 2024. Rates are per 1,000 Original Medicare Part B enrollees, so large states don’t rank high just because they are large. Switch to total services to see raw counts.
Headline: Vermont had the highest rate in 2024: 165.7 services per 1,000 Original Medicare Part B enrollees, about 11 times the rate in neighboring New Hampshire (14.5). Vermont has led every year since 2019, at 7 to 11 times New Hampshire’s rate. The gap widened in 2024 when New Hampshire’s total fell.
States are where the treating (rendering) provider is located, as listed in the national provider registry, not where the patient lives. Rates in small states can change a lot when a few clinics open or close.
About this data. Original Medicare Part B fee-for-service only. Source: CMS, 2024. These numbers show billing patterns, not quality of care or need.
Read the full note
This map uses public Medicare claims data from the Centers for Medicare & Medicaid Services (CMS), 2024. It covers Original Medicare Part B fee-for-service only. It leaves out Medicare Advantage, Medicaid, private insurance and cash-pay patients, whose payment rates can be very different. It also leaves out therapy billed by hospital outpatient departments and rehab agencies on facility claims. Services are counted by where the treating (rendering) provider is located, as listed in the national provider registry, not where the patient lives, and CMS hides very small counts to protect privacy. High or low numbers show billing patterns, not quality of care, need, or proper or improper billing. The Aquatic Therapy Foundation compiled these figures for public education, and they were independently checked against the CMS source files, but CMS data can be revised. Please check the CMS source data before relying on it. Spot an error? Email info@aquatictherapyfoundation.org.
Services per 1,000 Original Medicare Part B enrollees, 2024
Small Northeast states and DC are shown as squares on the right. Tap or click a state for details. Keyboard: Tab through the states, or use the table.
Pick a state
Hover, tap or tab to a state, or type its name in “Find your state.” You’ll see its rank, totals, a 2019–2024 trend line and a link you can share.
U.S. rate in 2024: 56.3 per 1,000
50 states and DC combined.
Top 5, 2024
Bottom 5
Close call: in 2024, Nebraska (#5, 123.7) and Idaho (#6, 123.1) were less than 1 point apart.
Did you know? In 2024, Original Medicare covered 1,570,017 units of 97113 (each unit is 15 minutes) for 46,355 patients. That works out to about 34 units, or about 8½ hours of billed pool time, per patient over the year.
Why is Vermont so high?
It isn’t one clinic. In 2024, 88 therapists in Vermont billed aquatic therapy to Original Medicare, at two dozen or more practice locations around the state, and no single therapist accounted for more than about 6% of the state’s total. Vermont’s private-practice therapists bill about the same amount of land-based therapeutic exercise per Medicare enrollee as New Hampshire’s. The difference is how much of it happens in the pool: about 13.5 aquatic units for every 100 therapeutic-exercise units in Vermont, the highest in the country, compared with 1.2 in New Hampshire and 2.4 nationally. Vermont reaches more patients (about 7 per 1,000 enrollees, vs. under 1 in New Hampshire), not more visits per patient. Vermont has led the country every year since 2019.
What this can’t tell you
Counts follow where the therapist practices, not where the patient lives. Therapy billed by hospital outpatient departments is not included, so states where aquatic therapy is mostly hospital-based may look low. The map shows how much aquatic therapy was billed, not whether it was needed or how good it was.
Data table: all 50 states and DC
How we built this
About this data. This map uses public Medicare claims data from the Centers for Medicare & Medicaid Services (CMS), 2024. It covers Original Medicare Part B fee-for-service only. It leaves out Medicare Advantage, Medicaid, private insurance and cash-pay patients, whose payment rates can be very different. It also leaves out therapy billed by hospital outpatient departments and rehab agencies on facility claims. Services are counted by where the treating (rendering) provider is located, as listed in the national provider registry, not where the patient lives, and CMS hides very small counts to protect privacy. High or low numbers show billing patterns, not quality of care, need, or proper or improper billing. The Aquatic Therapy Foundation compiled these figures for public education, and they were independently checked against the CMS source files, but CMS data can be revised. Please check the CMS source data before relying on it. Spot an error? Email info@aquatictherapyfoundation.org.
Methods
- Services: From the CMS dataset Medicare Physician & Other Practitioners – by Geography and Service, we took the rows for HCPCS code 97113 at the state level for data years 2019–2024 (the 2024 file is the latest CMS has released). Exact query for 2024: CMS data API, HCPCS 97113. Fields used: total services, total beneficiaries, total rendering providers (billing clinicians, counted as individual national provider identifiers, not clinics), average Medicare allowed amount and average Medicare payment.
- Enrollees: From the CMS dataset Medicare Monthly Enrollment, we took each state’s annual figure for Original Medicare Part B enrollees (field B_ORGNL_MDCR_BENES, month = “Year”) for the same year. Exact query for 2024: CMS data API, state annual enrollment.
- Rate: services ÷ Original Medicare Part B enrollees × 1,000. One service is one billed 15-minute unit.
- Ranks and colors: 50 states and DC are ranked from highest to lowest. Colors split the 51 into 5 groups with about the same number in each. Puerto Rico and the U.S. Virgin Islands are in the CMS file but are not ranked here.
- Pool share (Vermont box): 97113 units per 100 units of 97110 (therapeutic exercise on land) for the same state and year, from the same CMS file.
- Independent check: These figures were independently checked against the CMS source files (the full CSV downloads for 2019–2024). All state-year rows matched.
- Downloaded: October 23, 2026. The CSV button gives you every number on this page for 2019–2024.
What this map does not show
- Original Medicare Part B fee-for-service only. It leaves out Medicare Advantage (about 50% of Medicare enrollees in 2024 were in Medicare Advantage or other plans), Medicaid, private insurance and self-pay.
- Practitioner claims only. The CMS file is built from Part B claims sent by physicians and other practitioners, such as therapists in private practice. Therapy given by hospital outpatient departments and rehab agencies is billed on facility claims and isn’t counted here, so states where aquatic therapy runs mostly through hospital pools will look lower than they really are.
- Where the provider is, not the patient. States are where the treating (rendering) provider is located, as listed in the national provider registry, not where the patient lives.
- Small counts are hidden by CMS. CMS removes any figure based on fewer than 11 patients. For 97113 at the state level, no state was hidden in 2019–2024.
- 2020 was unusual. Services dropped during the COVID-19 pandemic.
- Use is not need, quality or access. A high or low rate doesn’t tell you whether care was right for patients. Don’t read it as a sign of good or bad billing.
Sources
- Centers for Medicare & Medicaid Services. Medicare Physician & Other Practitioners – by Geography and Service, data years 2019–2024. Downloaded October 23, 2026.
- Centers for Medicare & Medicaid Services. Medicare Monthly Enrollment, annual state figures 2019–2024. Downloaded October 23, 2026.
- Map boundaries: U.S. Census Bureau cartographic boundary files, through the open-source us-atlas project (simplified).
About code 97113: 97113 is the CPT® code number used in the United States to report a timed therapy procedure in which therapeutic exercise is performed in water. We describe it here in our own words. CPT® is a registered trademark of the American Medical Association. CPT codes, descriptions and other data only are copyright 2025 American Medical Association. All rights reserved. This page shows the code number only and does not reproduce the CPT descriptor.
Share this map
Picked a state? The share buttons and the copied link go straight to it.
Embed this map
Paste this code into your site. It shows the map image and links back here. You may embed this map free on any website, unchanged and with its credit line. Please don’t edit the image, remove the credit, or use it in anything sold without written permission.
Cite this map
Salzman, A. (Ed.). (2026). Medicare aquatic therapy (CPT 97113) use by state, 2024 [Interactive map]. Map of the Day #1. ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. Data: Centers for Medicare & Medicaid Services. https://aquatictherapyfoundation.org/aquatic-therapy-by-the-map/medicare-97113-by-state/
Explore the other maps
Back to Aquatic Therapy by the Map. New maps are added regularly.
- #2 What does Medicare pay for aquatic therapy?
Average Medicare allowed amount and payment per 15-minute unit of 97113, by state. - Coming soon Medicare 97113 change over time
Which states gained or lost Medicare aquatic therapy since 2019. - Coming soon Medicaid 97113 payment by state
What each state’s Medicaid program pays for aquatic therapy. - Coming soon Drowning deaths by state
Where drowning deaths are highest, and why water skills matter for every age. - Coming soon Pools and access
Where pools and water access are within reach, state by state. - Coming soon Evidence Library studies by country
Where the newest aquatic therapy research comes from, country by country. - Coming soon Aquatic therapy clinical trials by country
Where aquatic therapy clinical trials are happening around the world.
Related on this site
- Medicare local coverage documents for CPT® 97113
- Aquatic Therapy Evidence Library
- Encyclopedia: Aquatic exercise · Aquatic therapist · Aquatic therapy terminology
- For Clinicians
How to cite this page
Last checked October 23, 2026 · Permanent URL: https://aquatictherapyfoundation.org/aquatic-therapy-by-the-map/medicare-97113-by-state/
How to cite
Salzman, A. (Ed.). (2026). Medicare aquatic therapy (CPT 97113) use by state, 2024 [Interactive map]. Map of the Day #1. ATU Educational Services, LLC; published by the Aquatic Therapy Foundation. Data: Centers for Medicare & Medicaid Services. https://aquatictherapyfoundation.org/aquatic-therapy-by-the-map/medicare-97113-by-state/
Permissions: Free to read, link to and quote with citation. You may share or embed the map image unchanged, with its credit and link, using the embed code on this page. Copying or adapting the full page, the map design or the compiled table, or using them in anything sold (such as a course, book, app or paid report), requires written permission from ATU Educational Services, LLC. Permissions: info@aquatictherapyfoundation.org. For the underlying numbers, cite CMS and link to data.cms.gov.
Cite the date you accessed this page, because content may change.
This page was drafted with AI assistance under the editorial direction of the Aquatic Therapy Foundation, checked against its cited sources, and corrected when errors are reported. Report errors to info@aquatictherapyfoundation.org.
Last checked: October 23, 2026. This page is general education. It is not billing, coding, legal, reimbursement or medical advice. States are where the treating (rendering) provider is located, as listed in the national provider registry, not where the patient lives. Therapy billed by hospital outpatient departments and rehab agencies on facility claims is not included.
© 2026 ATU Educational Services, LLC. Licensed to the Aquatic Therapy Foundation, Inc. for public education.