Hippotherapy

Hippotherapy is a covered benefit under the Extended Care Health Option (ECHO) program. This type of therapy program on horses uses components of physical therapy and occupational therapy to improve balance, posture and coordination, and develop a positive attitude and sense of accomplishment.

Hippotherapy as a substitute for physical therapy or occupational therapy under the basic TRICARE benefit is not covered.

All TRICARE-eligible active duty family members who are enrolled in the ECHO program and have been diagnosed with multiple sclerosis or cerebral palsy are eligible for hippotherapy.

Services must be ordered by a physician attesting the beneficiary will benefit from these non-medical services above and beyond what is provided under the basic TRICARE benefit. Prior authorization under the ECHO program is required. After the initial evaluation, outcome goals must be established for therapy. Ongoing improvement must be documented to continue coverage.

Visit the ECHO Costs and Catastrophic Cap Information page for the monthly cost-share based on the sponsor’s rank. The maximum allowable for all services under the ECHO program, including hippotherapy is $36,000 per fiscal year (October 1–September 30). This maximum applies to each beneficiary, regardless of the number of dependents with the same sponsor receiving ECHO benefits in that fiscal year.

Providers of hippotherapy must be a TRICARE network or non-network certified physical or occupational therapist, and have obtained additional credentialing from the American Hippotherapy Certification Board (AHCB). The facility where services are rendered must be a Professional Association of Therapeutic Horsemanship International (PATH International) credentialed center.

Visit the AHCB or PATH International websites to learn more.

The following code should be billed when providing hippotherapy:

• equestrian therapy (hippotherapy) – HCPCS code S8940 per session

Only the professional services provided by the specific provider types outlined above are covered. Facility fees, stable fees or anything related to the care, feeding, maintenance, or equipment is not a covered benefit.

Reimbursement will be the lesser of the CHAMPUS Maximum Allowable Charge (CMAC), the negotiated rate or the billed charge.

To learn more on how to submit claims, visit our Claims page.