Hippotherapy, also referred to as equine movement therapy, is a form of therapeutic horseback riding, and has been proposed as a type of physical therapy for patients with impaired walking related to spastic cerebral palsy and other motor dysfunctions.

Investigational and Not Medically Necessary:

Hippotherapy is considered investigational and not medically necessary in all cases.

There is insufficient scientific data in the peer-reviewed medical literature to support the effectiveness of hippotherapy for the treatment of patients with 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.

Hippotherapy, also referred to as equine movement therapy, describes a form of physical therapy using horses. It is a form of therapeutic horseback riding or equestrian therapy. It has been proposed as a technique to decrease the energy requirements and improve walking in patients 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.

The following codes for treatments and procedures applicable to this policy 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 Policy section as investigational and not medically necessary.

Peer Reviewed Publications:

1. Benda W, McGibbon NH, Grant KL. Improvements in muscle symmetry in children with cerebral palsy after equine-assisted therapy (hippotherapy). J Altern Complement Med. 2003; 9(6):817-825.
2. Bertoti DB. Effect of therapeutic horseback riding on posture in children with cerebral palsy. Phys Ther. 1988; 68(10):1505-1512.
3. Keren O, Reznik J, Groswasser Z. Combined motor disturbances following severe traumatic brain injury: an integrative long-term approach. Brain Inj. 2001; 15(7):633-638.
4. Lechner HE, Kakebeeke TH, Hegemann D, Baumberger M. The effect of hippotherapy on spasticity and on mental well-being of persons with spinal cord injury. Arch Phys Med Rehabil. 2007 Oct;88(10):1241-1248.
5. McGibbon NH, Andrade CK, Widener G, Cintas HL. Effect of an equine-movement therapy program on gait, energy expenditure, and motor function in children with spastic cerebral palsy: a pilot study. Dev Med Child Neurol. 1998; 40(11):754-762.
6. Meregillano G. Hippotherapy. Phys Med Rehabil Clin N Am. 2004; 15(4):843-854.
7. Sterba JA. Does horseback riding therapy or therapist-directed hippotherapy rehabilitate children with cerebral palsy? Dev Med Child Neurol. 2007; 49(1):68-73.
8. Sterba JA, Rogers BT, France AP, Vokes DA. Horseback riding in children with cerebral palsy: effect on gross motor function. Dev Med Child Neurol. 2002; 44:301-308.

1. American Hippotherapy Association. Therapeutic Riding Program.  Available at: http://www.americanequestrian.com/hippotherapy.htm. Accessed on February 20, 2008.
2. North American Riding for the Handicapped Association (April 1997). Introduction to Hippotherapy.  Available at: http://www.narha.org/PDFfiles/tr_hippo.pdf. Accessed on February 20, 2008.

Equestrian Therapy
Equine Movement Therapy
Hippotherapy
Horseback Riding Therapy