Medical Policy


Subject:Hippotherapy
Policy #:  REHAB.00003Current Effective Date:  07/09/2013
Status:ReviewedLast Review Date:  05/09/2013

Description/Scope

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 individuals with impaired walking related to 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 the treatment of individuals 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.

An updated literature search through March 2013 did not identify any new literature to support the use of hippotherapy for those with spastic cerebral palsy and other motor dysfunctions.

Background/Overview

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. 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.  A draft of future ICD-10 Coding (effective 10/01/2014) related to this document, as it might look today, is included below for your reference.  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 
S8940Equestrian/hippotherapy, per session
  
ICD-9 Diagnosis 
 All diagnoses
  
ICD-10 DiagnosisICD-10-CM draft codes; effective 10/01/2014:
 All diagnoses
  
References

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. 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.
  3. 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; 88(10):1241-1248.
  4. 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.
  5. Silkwood-Sherer DJ, Killian CB, Long TM, Martin KS. Hippotherapy- an intervention to habilitate balance deficits in children with movement disorders: a clinical trial. Physical Therapy. 2013; 92(5):707-717.
  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.
Web Sites for Additional Information
  1. American Hippotherapy Association. Hippotherapy as a Treatment Strategy. Available at: http://www.americanhippotherapyassociation.org/hippotherapy/hippotherapy-as-a-treatment-strategy/. Accessed on March 23, 2013.
  2. Professional Association of Therapeutic Horsemanship International (PATH Intl.). What is PATH Intl.? Available at: http://www.pathintl.org/about-path-intl/about-path-intl. Accessed on March 23, 2013.
Index

Equestrian Therapy
Equine Movement Therapy
Hippotherapy
Horseback Riding Therapy

Document History

Status

Date

Action

Reviewed05/09/2013Medical Policy & Technology Assessment Committee (MPTAC) review. Updated References and Websites.
Reviewed05/10/2012MPTAC review. Updated references and websites.
Reviewed05/19/2011MPTAC review. Updated references and websites.
Reviewed05/12/2010MPTAC review. Updated references and websites.
Reviewed05/21/2009MPTAC review.  Updated references.
Reviewed05/15/2008MPTAC review. Updated review date, references and history sections of document.
 02/21/2008The phrase "investigational/not medically necessary" was clarified to read "investigational and not medically necessary." This change was approved at the November 29, 2007 MPTAC meeting.
Reviewed05/17/2007MPTAC review. References updated. 
Reviewed06/08/2006MPTAC review. Updated references. No change to document stance.
Revised07/14/2005MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.
Pre-Merger Organizations

Last Review Date

Document Number

Title

Anthem, Inc.

06/11/2001

REHAB.00003Hippotherapy
WellPoint Health Networks, Inc.

12/04/2003

10.01.13Equine Movement Therapy (Hippotherapy)