| Medical Policy |
| Subject: Hippotherapy | |
| Document #: REHAB.00003 | Publish Date: 12/16/2020 |
| Status: Reviewed | Last Review Date: 11/05/2020 |
| Description/Scope |
This document addresses hippotherapy, also referred to as equine movement therapy, which has been proposed as a type of physical, occupational, or speech and language therapy. This treatment strategy utilizes equine movement for individuals with impaired movement related to autism spectrum disorders, spastic cerebral palsy and other motor dysfunctions.
| Position Statement |
Investigational and Not Medically Necessary:
Hippotherapy is considered investigational and not medically necessary in all cases.
| Rationale |
There is insufficient scientific data in the peer-reviewed medical literature to support the effectiveness of hippotherapy for any indication, including but not limited to the treatment of individuals with autism spectrum disorders, cerebral palsy or other motor dysfunction such as arthritis, multiple sclerosis, head injury, and stroke.
The majority of the literature regarding hippotherapy consists of small case series published in the German literature. English language publications also consist of small case series (Benda, 2003; McGibbon, 1998). Sterba and colleagues (2002) reported on the outcomes of horseback riding in 17 subjects with cerebral palsy. Gross motor function measurements were assessed before and after a once weekly horseback riding program for 18 weeks. Gross motor function total scores improved by 7.6% after 18 weeks, returning to baseline 6 weeks after the program ended. This small trial is inadequate to permit scientific conclusions.
In 2015, Kwon and colleagues reported results from a randomized controlled trial of children (4-10 years old) with cerebral palsy. A total of 91 subjects were randomized to the intervention group with hippotherapy for 30 minutes twice weekly (n=45) or the control group with home-based aerobic exercise (n=46) for a total of 8 consecutive weeks. The Baseline Gross Motor Function Measure (GMFM) (GMFM-66 and GMFM-88) total and dimension scores did not significantly differ between groups. The initial short-term benefits of hippotherapy in children with cerebral palsy showed promise, although further studies are needed to assess the maintenance effect of hippotherapy over time.
An updated literature search based on the MEDLINE database through September 2020 did not identify any new literature that supports the use of hippotherapy for those with autism spectrum disorders, spastic cerebral palsy and other motor dysfunctions.
| Background/Overview |
Hippotherapy, also referred to as equine movement therapy, describes a form of physical, occupational or speech and language therapy using horses. It is a form of therapeutic horseback riding or equestrian therapy. This treatment strategy has been proposed as a technique to decrease the energy requirements and improve walking in individuals with cerebral palsy. It is thought that the natural swaying motion of the horse induces a pelvic movement in the rider that simulates human ambulation. In addition, variations in the horse’s movements can also prompt natural equilibrium movements in the rider. To attain specific postural responses, the therapist may place the rider in different positions on the horse, such as sitting, side sitting, prone or side lying. In many cases, the therapist will ride with the rider in order to facilitate the movement or desired response.
Hippotherapy has also been proposed as a therapeutic treatment for other disorders or conditions such as traumatic brain injury, stroke, multiple sclerosis, autism, spina bifida, learning disabilities, and mental retardation.
| Coding |
The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.
When services are Investigational and Not Medically Necessary:
For the following procedure code in all instances, or when the code describes a procedure indicated in the Position Statement section as investigational and not medically necessary.
| HCPCS |
|
| S8940 | Equestrian/hippotherapy, per session |
|
|
|
| ICD-10 Diagnosis |
|
|
| All diagnoses |
| References |
Peer Reviewed Publications:
| Websites for Additional Information |
American Hippotherapy Association Inc. What is hippotherapy? Available at: https://www.americanhippotherapyassociation.org/what-is-hippotherapy. Accessed on September 10, 2020.
Professional Association of Therapeutic Horsemanship International (PATH Intl.). About PATH Intl. Available at: http://www.pathintl.org/about-path-intl/about-path-intl. Accessed on September 10, 2020.
| Index |
Equestrian Therapy
Equine Movement Therapy
Hippotherapy
Horseback Riding Therapy
| Document History |
| Status | Date | Action |
| Reviewed | 11/05/2020 | Medical Policy & Technology Assessment Committee (MPTAC) review. Updated Rationale, References and Websites sections. |
| Reviewed | 11/07/2019 | MPTAC review. Updated Rationale, References and Websites sections. |
| Reviewed | 01/24/2019 | MPTAC review. Updated Rationale, References and Websites sections. |
| Reviewed | 03/22/2018 | MPTAC review. The document header wording updated from “Current Effective Date” to “Publish Date”. Updated Rationale and References sections. |
| Reviewed | 05/04/2017 | MPTAC review. Updated Rationale and References sections. |
Federal and State law, as well as contract language, including definitions and specific contract provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. The member’s contract benefits in effect on the date that services are rendered must be used. Medical Policy, which addresses medical efficacy, should be considered before utilizing medical opinion in adjudication. Medical technology is constantly evolving, and we reserve the right to review and update Medical Policy periodically.
No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan.
© CPT Only - American Medical Association