Aetna modified CPB 0151 for hippotherapy, effective September 26, 2025. Here's what billing teams need to know.
Aetna, a CVS Health company, updated its hippotherapy coverage policy under CPB 0151 on September 26, 2025. The policy governs HCPCS code S8940 — equestrian/hippotherapy, per session — and the update affects claims billed across a broad range of diagnoses spanning neurological, musculoskeletal, psychiatric, and developmental conditions. If your practice or facility bills S8940 for Aetna members, this policy change belongs on your radar now.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Hippotherapy – CPB 0151 |
| Policy Code | CPB 0151 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High |
| Specialties Affected | Physical therapy, occupational therapy, speech-language pathology, pediatric rehabilitation, neurology, behavioral health |
| Key Action | Audit all pending and future S8940 claims for Aetna members before billing — this service is explicitly non-covered across all listed indications |
Aetna Hippotherapy Coverage Criteria and Medical Necessity Requirements 2025
The Aetna hippotherapy coverage policy under CPB 0151 is unambiguous: S8940 is not covered. Full stop.
Aetna does not recognize hippotherapy as meeting medical necessity criteria for any of the conditions listed in this bulletin. That list is long — 184 ICD-10-CM codes spanning cerebral palsy (G80.0–G80.9), multiple sclerosis (G35), Parkinson's disease (G20.A1–G20.C), Alzheimer's disease (G30.0–G30.9), epilepsy (G40.001–G40.C19), autism spectrum disorder, cerebrovascular disease (I60.00–I69.998), musculoskeletal disorders (M00.00–M99.9), and a wide range of psychiatric and behavioral conditions (F01.50–F99).
The coverage policy treats hippotherapy — the use of a horse's movement as a therapeutic modality — as unproven for all these indications. Aetna does not view the clinical evidence as sufficient to support reimbursement, regardless of diagnosis.
This is not a prior authorization issue. There is no path through prior authorization to get S8940 covered. Aetna has categorized this service as not covered across the board, which means prior auth requests will not change the outcome. Don't waste your team's time submitting PA requests for hippotherapy sessions.
The breadth of diagnoses listed is notable. Aetna covers the underlying conditions — cerebral palsy, MS, autism — through standard rehabilitative therapies billed under CPT codes for PT, OT, and speech. But the horse-based delivery mechanism is the disqualifying factor here, not the diagnosis itself.
Aetna Hippotherapy Exclusions and Non-Covered Indications
Every indication covered in CPB 0151 falls into the non-covered category. The policy groups S8940 under "HCPCS codes not covered for indications listed in the CPB."
The diagnostic scope is deliberately wide. Aetna appears to be closing off any ambiguity about whether hippotherapy might be covered for a particular condition. The message is consistent: the modality itself — equestrian therapy — is the exclusion, not the diagnosis.
Here's where billing teams sometimes get into trouble. A patient presents with cerebral palsy (G80.2) or an autism diagnosis, and a clinician recommends hippotherapy as a complement to conventional therapy. The team assumes the underlying diagnosis supports coverage. It doesn't — not for S8940, not under this policy.
The real issue here is that some providers bill hippotherapy under physical therapy CPT codes, hoping to avoid S8940 entirely. That approach creates significant compliance exposure. If the service delivered is hippotherapy, the code should reflect that. Miscoding to avoid a non-covered code is a billing integrity problem — talk to your compliance officer before going that route.
Coverage Indications at a Glance
| Indication | Coverage Status | Relevant Codes | Notes |
|---|---|---|---|
| Hippotherapy (equestrian therapy), all indications | Not Covered | S8940 | Explicit non-coverage under CPB 0151 for all listed diagnoses |
| Cerebral palsy | Not Covered for hippotherapy | G80.0–G80.9 | Conventional PT/OT/speech may still be covered separately |
| Multiple sclerosis | Not Covered for hippotherapy | G35 | Standard MS therapies unaffected |
| Parkinson's disease | Not Covered for hippotherapy | G20.A1–G20.C | Standard neuro rehab unaffected |
| Alzheimer's disease | Not Covered for hippotherapy | G30.0–G30.9 | Cognitive therapies billed separately |
| Epilepsy and recurrent seizures | Not Covered for hippotherapy | G40.001–G40.C19 | Standard neurology management unaffected |
| Autism spectrum and behavioral disorders | Not Covered for hippotherapy | F01.50–F99 (range) | ABA and other behavioral therapies unaffected |
| Cerebrovascular disease / stroke | Not Covered for hippotherapy | I60.00–I69.998 | Conventional stroke rehab unaffected |
| Musculoskeletal and connective tissue disorders | Not Covered for hippotherapy | M00.00–M99.9 | PT/OT under standard CPT codes unaffected |
| Childhood obesity | Not Covered for hippotherapy | E66.811–E66.89, E66.9 | Obesity management programs unaffected |
| Chronic pain | Not Covered for hippotherapy | G89.21–G89.4 | Pain management under other modalities unaffected |
| Vestibular disorders / vertigo | Not Covered for hippotherapy | H81.01–H82.9, H83.2X1–H83.2X9, R42, A88.1 | Vestibular rehab under standard PT codes unaffected |
| Developmental disorders | Not Covered for hippotherapy | R62.0–R62.7 | Developmental therapy through standard pathways unaffected |
| Eating disorders | Not Covered for hippotherapy | F50.0–F50.9 | Behavioral health services unaffected |
| Dyslexia and symbolic dysfunctions | Not Covered for hippotherapy | R48.0–R48.9 | Educational and speech therapy unaffected |
| Muscular dystrophy and primary muscle disorders | Not Covered for hippotherapy | G71.0–G71.9 | Neuromuscular rehab under standard codes unaffected |
Aetna Hippotherapy Billing Guidelines and Action Items 2025
This policy has a September 26, 2025 effective date. If your billing team is still submitting S8940 claims — or you have outstanding appeals — here's what to do now.
| # | Action Item |
|---|---|
| 1 | Pull all S8940 claims billed to Aetna on or after September 26, 2025. Review each one for claim denial risk. This code is explicitly non-covered under CPB 0151. Any claim submitted is heading toward a denial. |
| 2 | Audit your charge capture workflow for hippotherapy sessions. If your EHR or billing system defaults S8940 into the charge queue for certain diagnoses, fix that default before it generates another denial. The effective date has already passed. |
| 3 | Do not substitute conventional PT or OT CPT codes for hippotherapy services. If the clinical service delivered is hippotherapy, S8940 is the correct code. Billing CPT 97110 (therapeutic exercises) or CPT 97530 (therapeutic activities) for a hippotherapy session to avoid the non-covered designation creates compliance risk that far outweighs the denial. |
| 4 | Counsel patients and referring providers on the non-covered status. If physicians or therapists refer Aetna members for hippotherapy, they need to know reimbursement is off the table under this coverage policy. Patients should be informed — in writing — before services begin, consistent with your advance beneficiary notice or equivalent patient financial responsibility process. |
| 5 | Check whether hippotherapy is offered as a self-pay or sliding-scale service. Some practices provide hippotherapy outside the insurance billing context entirely. If that's your model, make sure your billing team isn't accidentally submitting these sessions to Aetna. One accidental submission creates documentation exposure. |
| 6 | Review open appeals for S8940 denials. If you have any appeals in flight for hippotherapy claims with Aetna, assess whether they're worth pursuing. Given the explicit non-coverage language in CPB 0151, the appeal path is steep. Talk to your billing consultant about whether the clinical record supports an argument that the service delivered was conventional PT performed in a non-traditional setting — a different claim entirely from hippotherapy. |
| 7 | Check your contracts and Explanation of Benefits language. Some employer group plans have supplemental benefits or carve-outs. A small number of self-funded plans may override Aetna's standard coverage policy. Always check the member's specific plan documents before writing off S8940 as universally non-billable for every Aetna product. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Hippotherapy Under CPB 0151
Not Covered HCPCS Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| S8940 | HCPCS | Equestrian / hippotherapy, per session | Not covered for indications listed in CPB 0151 |
Key ICD-10-CM Diagnosis Codes Listed in CPB 0151
These are the diagnoses Aetna explicitly addresses in this policy. All are in the non-covered context — hippotherapy billed for any of these diagnoses will be denied under CPB 0151.
| Code | Description |
|---|---|
| A88.1 | Epidemic vertigo |
| E66.811–E66.89 | Other obesity (childhood obesity) |
| E66.9 | Obesity, unspecified |
| F01.50–F99 | Mental and behavioral disorders (broad range) |
| F50.0–F50.9 | Eating disorders |
| G20.A1–G20.C | Parkinson's disease |
| G30.0–G30.9 | Alzheimer's disease |
| G35 | Multiple sclerosis |
| G40.001–G40.C19 | Epilepsy and recurrent seizures |
| G71.0–G71.9 | Primary disorders of muscles |
| G80.0–G80.9 | Cerebral palsy |
| G89.21–G89.4 | Chronic pain |
| H81.01–H82.9 | Disorder of vestibular function and vertiginous syndromes |
| H83.2X1–H83.2X9 | Labyrinthine dysfunction |
| I60.00–I69.998 | Cerebrovascular diseases |
| M00.00–M99.9 | Diseases of the musculoskeletal system and connective tissue |
| R25.0–R29.91 | Symptoms and signs involving the nervous and musculoskeletal systems |
| R42 | Dizziness and giddiness |
| R48.0–R48.9 | Dyslexia and other symbolic dysfunctions |
| R62.0–R62.7 | Lack of expected normal physiological development |
| R63.2 | Polyphagia |
| R68.0–R68.13 | Other general symptoms and signs |
Note: The full policy includes 184 ICD-10-CM codes. The ranges above represent the complete set as provided in CPB 0151. Review the full bulletin at the Aetna source document for the complete code list before finalizing your billing guidelines.
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