CurrentExecutive Office of Health and Human ServicesPolicy N/A

Hippotherapy (equine-assisted physical/occupational/speech therapy) coverage criteria

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Policy governing coverage and provider participation requirements for individually developed hippotherapy services for children with severe or developmental disabilities under Rhode Island Medicaid (EPSDT). It addresses provider certification, service delivery, billing codes, and documentation/limitations.

Policy Summary

PayerExecutive Office of Health and Human Services

PolicyHippotherapy (equine-assisted physical/occupational/speech therapy) coverage criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionMaintain clinical records (evaluations, goals, objectives) and include a physician (MD/DO) prescription documenting diagnosis and medical necessity.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not authorized (except ≤4)group therapy policy

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CurrentExecutive Office of Health and Human ServicesPolicy N/A

Hippotherapy (equine-assisted physical/occupational/speech therapy) coverage criteria

Customize your policy alerts

Sign up for all Executive Office of Health and Human Services policy alerts

Know when Executive Office of Health and Human Services releases new policies or updates existing guidance.

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Policy Summary

PayerExecutive Office of Health and Human Services

PolicyHippotherapy (equine-assisted physical/occupational/speech therapy) coverage criteria

Policy CodePolicy N/A

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionMaintain clinical records (evaluations, goals, objectives) and include a physician (MD/DO) prescription documenting diagnosis and medical necessity.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

Not authorized (except ≤4)group therapy policy

Coverage Criteria for Hippotherapy

Covered Hippotherapy services

Covered when ALL of the following are met

Eligibility and program: Patient is a child with severe disabilities (including developmental disabilities) and services are provided under the Early Periodic Screening, Diagnosis and Treatment (EPSDT) Program of Rhode Island Medicaid.

from Introduction

Service plan and delivery: Hippotherapy is an individually developed plan of specialized physical, occupational, or speech therapy conducted on horseback and must be provided by on-site licensed Physical Therapy, Occupational Therapy, or Speech Therapy personnel.

service definition and delivery

Performing provider qualifications: Therapists (performing providers) delivering hippotherapy must be A.H.A. (American Hippotherapy Association) certified and licensed to practice therapy in the state where services are provided.

provider qualifications

Billing provider requirements: Billing provider may be certified by NARHA (North American Riding for the Handicapped Association) and must be enrolled in the Rhode Island Medical Assistance Program.

billing provider participation

Group therapy limitation: Group therapy is generally not authorized; when group sessions occur they must be limited to no more than 4 children and must be provided by a licensed physical therapist, occupational therapist, or speech, hearing and language therapist.<= 4 children

limitations #2

Documentation and prescription: Clinical records including evaluations, goals, and objectives must be maintained in the medical record by the billing provider, and a prescription from the child's physician (MD or DO) indicating diagnosis and medical necessity must be included.

limitations #1

Billing and coding: Services must be billed as physical therapy, occupational therapy, or speech therapy per applicable CPT procedure codes.

limitations #4

Prior authorization is not required at this time (subject to change by DHS).

limitations #3

Hippotherapy services are covered only when delivered as an individually developed plan of specialized physical, occupational, or speech therapy for children with severe or developmental disabilities and provided under EPSDT through Rhode Island Medicaid. Services must be provided on-site by a licensed Physical Therapist, Occupational Therapist, or Speech Therapist who is A.H.A. certified. Clinical records, including evaluations, goals, and objectives, must be maintained by the billing provider, and a physician (MD or DO) prescription documenting diagnosis and medical necessity must be included in the record. Services must be billed as physical therapy, occupational therapy, or speech therapy.

Group therapy is not authorized as a routine service. If group sessions are used, they must be limited to no more than 4 children and must be provided by a licensed Physical Therapist, Occupational Therapist, or Speech, Hearing and Language Therapist. Lack of the required physician prescription or missing clinical documentation (evaluations, goals, objectives) may result in nonpayment or denial.

A prescription from the child’s physician (MD or DO) indicating the child’s diagnosis and medical necessity must be included in the clinical record maintained by the billing provider. Prior authorization is not required at this time, but this is subject to change by DHS; providers should retain complete documentation to support medical necessity and billing.

Billing Codes and Coding Guidance

Covered CPT Codes (as listed)CPTCovered

97001	PHYSICAL THERAPY EVALUATION
97003	OCCUPATIONAL THERAPY EVALUATION
97150	THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS)

Covered CPT Codes (as listed) - modifiers/pamixed

No codes listed

Therapeutic procedure codes/detailsCPTCovered

97001 (therapeutic procedure)	THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH AND ENDURANCE, RANGE OF MOTION AND FLEXIBILITY
97003 (therapeutic procedure)	THERAPEUTIC PROCEDURE, ONE OR MORE AREAS, EACH 15 MINUTES; THERAPEUTIC EXERCISES TO DEVELOP STRENGTH AND ENDURANCE, RANGE OF MOTION AND FLEXIBILITY

Provider Requirements, Documentation, and Actions

Prior Authorization

Prior authorization not required (subject to change)

Prior authorization is not required at this time; this status is subject to change by DHS.

Note

Provider & service format requirements

Services must be part of an individually developed plan provided on-site by a licensed Physical Therapist, Occupational Therapist, or Speech Therapist who is A.H.A. certified; group therapy is not authorized except limited group sessions of no more than 4 children provided by a licensed therapist.

Plan must be developed and services provided by an on-site licensed PT, OT, or Speech Therapist (A.H.A. certified).
Group sessions, when allowed, are limited to no more than 4 children and must be provided by a licensed PT, OT, or speech/hearing/language therapist.

Definitions and Provider Qualifications

inv-11: Definition of Hippotherapy

DefinitionAn individually developed plan of specialized physical, occupational, or speech therapy conducted on horseback by specially trained (American Hippotherapy Association - A.H.A.) certified personnel and provided by an on-site licensed Physical Therapist, Occupational Therapist, or Speech Therapist.

Target populationChildren with severe disabilities, including developmental disabilities, under EPSDT (Rhode Island Medicaid).

Service settingProvided on-site by a licensed therapist as part of an individually developed therapy plan.

Group therapy statusGroup therapy is not authorized (except as limited by other policy provisions).

inv-12: Billing provider requirements

Billing provider certification

Background

Hippotherapy is delivered on horseback as an individualized therapeutic intervention to address physical, occupational, or speech therapy goals in children with severe or developmental disabilities. The service is provided by specially trained personnel (A.H.A. certified) as part of an individually developed plan and must be performed on-site by a licensed therapist.