Equine therapy is the use of horses in a structured clinical setting to support physical, cognitive, or emotional treatment goals. Families researching the modality almost always arrive with the same question: will any of this be paid for?
The short answer is sometimes.
Insurance can cover equine work when a licensed clinician delivers it as recognized therapy, such as physical, occupational, speech, or psychotherapy, and bills it that way. Recreational riding and most stand-alone equine programs typically are not covered.
Here at D'Amore Mental Health, equine therapy is one of the experiential modalities we integrate into our residential and outpatient mental health programs. This guide explains how coverage actually works, what to ask your plan, and how equine work fits inside that structure.
Insurance covers equine therapy only when a licensed clinician delivers it as recognized therapy and bills it that way. Recreational riding almost never qualifies.
When equine work is part of a residential or outpatient mental health program, it usually falls under the program's clinical benefit instead of a separate equine charge. The fastest way to know what your plan covers is to verify benefits with your insurer or with our admissions team.
Key Takeaways
Does Insurance Cover Equine Therapy: The Short Answer
Insurance covers equine therapy in narrow circumstances. The deciding factors are:
When those three line up with a payer's clinical policy, equine-assisted work can be reimbursed under standard therapy benefits. When they don't, most plans deny the claim or treat the service as out-of-pocket.
For families researching options, this is the most useful frame: payers don't reimburse "equine therapy" as a category. They reimburse skilled clinical services that may incorporate horses.
That distinction is small in language and large in practice. It's also why the same activity can be paid by one insurer and denied by another, depending on how the provider documents and codes the visit.
Why Licensure and Medical Necessity Matter
Insurers use clinician licensure to decide whether a session is therapy or recreation.
A session led by a licensed physical, occupational, or speech therapist can be billed under standard therapy codes. A session led by an instructor without clinical licensure usually cannot.
The same logic applies on the mental-health side. A licensed mental-health clinician can bill psychotherapy codes when sessions meet psychotherapy criteria, while a coach or facilitator typically cannot.
Medical necessity is the second pillar. Payers want to see:
Without that documentation, even a licensed clinician's session may be denied as "not medically necessary." For a broader picture of how mental health benefits work, see our overview of insurance coverage for mental health treatment.
What to Ask Your Insurer Before Scheduling
Most denials are avoidable when you ask the right questions upfront. Call your plan's member services line and confirm:
Get the representative's name and a reference number for the call. That paper trail makes appeals far easier if a claim is denied later.
Types of Equine-Assisted Services and Why Coverage Differs
Equine-assisted services break down into three categories, and each has a different coverage outlook. The table below summarizes the differences before we walk through each one in detail.
Hippotherapy
Hippotherapy is a clinician-directed treatment that uses equine movement to address neuromotor and sensory impairments. Licensed physical, occupational, or speech-language therapists run the sessions with measurable functional goals, including:
Because it is skilled therapy, insurers can reimburse hippotherapy when it's billed under standard therapy codes and tied to a documented plan of care. The CMS therapy services overview outlines how skilled therapy is evaluated.
Therapeutic Riding
Therapeutic riding emphasizes horsemanship, recreation, and confidence-building. Sessions are typically led by certified instructors rather than licensed therapists, and goals tend to be social, adaptive, or recreational.
Most payers classify this as instructional rather than clinical, so claims are usually denied. Therapeutic riding has real value for quality of life, but most insurers do not treat it as billable medical care.
Equine-Assisted Psychotherapy
Equine-assisted psychotherapy uses horse interaction to support work on several mental-health concerns, including:
When the session is delivered by a licensed mental-health clinician and meets standard psychotherapy criteria, it can be billed under psychotherapy codes. Coverage depends on the clinician's credentials, an appropriate psychiatric diagnosis, and treatment plan documentation.
Some plans approve sessions readily; others require detailed prior authorization.
Equine-assisted psychotherapy often sits alongside other experiential therapy modalities inside a clinical program.
How Private Insurance, Medicare, and Medicaid Approach Equine Therapy
Coverage rules differ sharply by payer type, and the framing matters when you're calling to verify benefits.
Commercial plans review hippotherapy case by case. They generally require a licensed therapist, standard therapy CPT codes, a documented plan of care, and prior authorization for many requests.
Some carriers publish medical policies classifying hippotherapy as investigational; others approve it when documentation supports medical necessity. Even within the same carrier, rules can vary across employer groups and states.
Medicare pays for skilled physical, occupational, or speech therapy when services are reasonable and necessary and delivered by qualified clinicians.
Medicare does not recognize the equine-specific HCPCS code (S8940), so providers who incorporate equine movement into PT, OT, or speech therapy typically bill standard therapy CPT codes. The Medicare Benefit Policy Manual outlines the documentation criteria that apply.
Medicaid coverage varies by state. Some state plans allow hippotherapy under PT or OT benefits with prior authorization; others exclude it.
Veterans benefits and adaptive-sports grants can also fund equine work through specific programs, though medical coverage differs by facility and requires program approvals.
For broader context on how the level of care you're considering shapes what insurance covers, our guide to understanding treatment levels breaks down what's typically included at each tier.
What Insurer Policies Tend to Look Like
Many commercial plans review hippotherapy case by case rather than treating it as a standard benefit. Some carriers have published medical policies classifying hippotherapy as investigational.
Others approve it when a licensed PT, OT, or SLP documents measurable functional goals and obtains prior authorization. Plan rules vary even within the same carrier across employer groups and states, so member-specific verification is the only reliable answer.
How Equine Therapy Is Covered Inside a Residential or Outpatient Program
When equine therapy is one piece of a larger residential or outpatient mental health program, it usually isn't billed as a separate service. Instead, the program's per-diem or level-of-care rate covers the full clinical schedule:
That means a plan that has authorized residential mental health treatment is generally paying for the full schedule, including any equine work the clinical team builds into your plan.
The trade-off is straightforward.
You can't pull equine therapy out of a residential program and have it covered separately if you aren't enrolled. The coverage path runs through the program admission, not through a stand-alone equine claim.
For families weighing options, this is often the most realistic way for equine work to be paid for at all.
To see how this works inside our residential mental health treatment or outpatient program, our admissions team can walk you through how your plan handles experiential modalities and what your level of care includes.
Many families are also weighing residential versus outpatient care more broadly. Our breakdown of inpatient versus outpatient mental health treatment covers the differences in structure, clinical intensity, and how insurance typically handles each.
Which Conditions Are Most Likely to Be Covered
Approval is most consistent for conditions with measurable motor or functional deficits.
Cerebral palsy and other neuromotor disorders have the strongest coverage precedent because hippotherapy can target specific outcomes such as gait, balance, and postural control. A 2020 systematic review in Children found that hippotherapy improved gross motor function in children with cerebral palsy.
Approval is less consistent for mental-health conditions, though still possible.
Equine-assisted psychotherapy may qualify for PTSD and trauma, anxiety, or autism-related care when sessions are tied to a psychiatric diagnosis and documented behavioral or functional goals.
Payers want to see the same elements they look for in any psychotherapy claim: a diagnosis, a treatment plan, measurable progress, and a licensed clinician.
Severity, Documentation, and Approval
Severity and documented functional deficits affect approval rates. Payers expect quantifiable progress, such as Gross Motor Function Measure (GMFM) scores or Timed Up and Go results, rather than narrative statements.
The cleanest packets include clinician-directed treatment plans, scheduled outcome reporting, and progress notes from a licensed clinician.
Pediatric PT and OT have stronger evidence and clearer billing precedent, so coverage is most likely when programs are medically focused and clinician-led.
How Equine Therapy Gets Billed
Whether equine therapy is paid for depends on how it's billed: under standard therapy CPT codes by a licensed clinician, or under an equine-specific code most plans deny.
The HCPCS code most directly tied to equine work is S8940, equestrian or hippotherapy per session. Most commercial plans either don't recognize S8940 or treat it as investigational, and Medicare doesn't recognize S-codes at all.
That's why licensed therapists who incorporate equine movement into PT, OT, or speech therapy typically bill standard therapy CPT codes instead. Common examples include:
Documentation must describe the skilled intervention, not the horse.
Notes should record what the clinician did, what functional goal it targeted, and how the client responded. When equine-assisted psychotherapy is billed, the same logic applies on the mental-health side, with standard psychotherapy codes (such as 90834 or 90837) tied to a psychiatric diagnosis and a treatment plan.
How Patient Cost Share Can Change
Out-of-pocket cost depends on several factors:
Rather than quoting a range that's unlikely to match your plan, the more useful step is to verify benefits in advance and confirm the exact CPT or HCPCS codes the provider intends to bill.
That way you know what your plan will recognize and where you might have member responsibility.
How to Verify Your Insurance Coverage
Verifying coverage takes three steps. The more specific you are on the call, the more useful the answer will be.
Step 1: Confirm the Plan Basics
Have your member ID ready. Ask for your plan name, group number, in-network behavioral health benefits, and how your deductible, copay, and coinsurance apply to outpatient and residential services.
Step 2: Name the Exact Service and Codes
Ask whether the plan covers hippotherapy, therapeutic riding, or equine-assisted psychotherapy by name. Ask which CPT or HCPCS codes the plan accepts.
If the provider intends to bill standard therapy codes (97110, 97112, 97116, 97530) or psychotherapy codes (90834, 90837), confirm those specifically.
Step 3: Verify Provider Credentials and Authorizations
Confirm the required provider type (licensed PT, OT, SLP, LMFT, LCSW, or psychologist).
Ask about prior authorization requirements, medical-necessity criteria, session limits, group versus individual rules, and the appeal window if a claim is denied. Document the representative's name and a reference number for every call.
If you'd like our admissions team to run this verification with you, they can usually complete it the same day.
If a Claim Is Denied
File a first-level appeal within your plan's window. The strongest appeals include:
If the internal appeal fails, most plans allow external review. PATH Intl. centers, EAGALA-affiliated nonprofits, and community foundations sometimes offer sliding-scale or scholarship funding when insurance denies coverage.
What Documentation Insurers Expect
Insurers approve equine therapy claims faster when the provider submits a complete documentation packet upfront. Records should be clinical, dated, and consistent with the insurer's published criteria.
The standard packet includes:
For appeals, add standardized outcome data, prior authorization history, and a clinician narrative that links interventions to medical necessity.
A clear, objective packet improves the odds of approval and gives the clinical team a stronger case to make.
Finding Equine Therapy Providers Who Accept Insurance
Start with the in-network therapy directory inside your insurance portal, then narrow by clinicians who hold hippotherapy or equine-assisted credentials.
Hospital outpatient rehabilitation programs and pediatric therapy clinics sometimes partner with equine centers, and PT, OT, and SLP professional directories often list providers with equine training.
When you're evaluating a program, focus on credentials and safety:
If insurance declines payment, PATH Intl. centers, EAGALA-affiliated nonprofits, and community foundations may offer scholarships or sliding-scale programs.
Integrating Equine Therapy with Residential or Intensive Mental-Health Care
Equine therapy is most often paid for when it sits inside a larger residential or outpatient program.
Coordinating equine work with the broader clinical plan helps preserve continuity of care and keeps the work tied to documented goals. A 2022 scoping review found that equine services are commonly integrated into substance-use and mental-health settings.
For our clients, our clinical team coordinates experiential modalities, including equine work, alongside DBT, CBT, trauma-focused therapy, and medication management.
Sessions are linked to individualized treatment plans, and outcomes are tracked in progress notes so the whole clinical team can see what's working.
For many clients, the regulatory and relational skills built in equine sessions carry back into the residential milieu and into life after discharge.
Frequently Asked Questions About Insurance and Equine Therapy
Get help verifying coverage and coordinating care.
If you're weighing whether equine therapy is part of the right level of care for you or a loved one, our admissions team can review your plan, walk through what documentation your clinician will need, and assist with prior authorization.
Medical disclaimer. The information on this page is educational and is not medical, billing, or legal advice. Coverage rules vary by insurer, plan, state, and clinician. Verify benefits with your insurance company and consult a licensed clinician before making treatment decisions.
If you are in crisis, call or text 988 for the Suicide and Crisis Lifeline.
