In some cases, yes—but only under certain circumstances. Whether equine-assisted psychotherapy (EAP) is covered depends on your insurance plan, the provider’s credentials, how services are documented and billed, and the terms of the provider’s insurance contract.
Disclaimer: This information is for educational purposes only and is not legal, billing, or insurance advice. It reflects our clinical experience over the past 15 years and should not be interpreted as guidance on billing insurance. Providers should consult an attorney, certified medical biller, or insurance compliance professional regarding their specific circumstances.
Licensed Provider Requirement
Mental health services are generally billed by a licensed mental health professional acting within their scope of practice. If insurance reimbursement is sought, the provider typically must be credentialed with the client’s insurance plan (unless billing as an out-of-network provider).
In our experience, some equine-assisted psychotherapy practices have charged an additional “barn fee” alongside the client’s copay or coinsurance. Depending on the provider’s insurance contract and applicable laws, this could be considered balance billing. Providers should carefully review their payer contracts and consult legal counsel before implementing additional fees.
Specialized Training
Although insurance companies do not generally require a specific equine-assisted therapy certification, providers should obtain appropriate education and training to ensure they are practicing within their scope of competence and in accordance with their professional code of ethics.
Out-of-Network Benefits
If a provider is not contracted with a client’s insurance plan, they may be able to provide a superbill for the client to submit for possible out-of-network reimbursement if the client’s plan includes those benefits. Providers generally need an active National Provider Identifier (NPI) to issue a superbill.
Medical Necessity
In some situations, a physician or other qualified healthcare provider may provide a Letter of Medical Necessity to support a client’s request for coverage or reimbursement. While this does not guarantee payment, it may be helpful in certain cases. In our experience, reimbursement is often partial rather than full.
Care Manager Advocacy
Some insurance companies offer care management services. Clients may request to work with a care manager to review their treatment history and help coordinate behavioral health services. In our experience, clients who have not responded well to traditional treatment approaches or multiple medication trials have occasionally received assistance identifying higher levels of care or obtaining out-of-network authorization when appropriate.
Insurance Limitations
There is currently no CPT code specific to equine-assisted psychotherapy. Mental health providers typically bill using standard psychotherapy CPT codes (such as 90834 or 90837) when appropriate and supported by documentation.
Some insurance policies or provider contracts specifically state that equine-assisted therapy is not a covered service. Providers should carefully review their contracts before advertising or billing for these services.
Equine-assisted psychotherapy also involves expenses that traditional office-based therapy does not, including horse care, facility maintenance, specialized liability insurance, and ongoing training. For this reason, many providers determine that participating with insurance panels is not financially sustainable.
Our agency accepted insurance for approximately one year before transitioning away from insurance participation due to the significant overhead associated with providing equine-assisted psychotherapy.
A Note About Industry Terminology
The field of equine-assisted services includes many different disciplines, such as therapeutic riding, adaptive riding, equine-assisted learning, and equine-assisted psychotherapy. Because these services are sometimes grouped together under similar terminology, confusion can occur regarding insurance coverage.
In our experience, licensed mental health professionals trained in equine-assisted psychotherapy—including many clinicians trained in The Icarus Model®—have successfully billed standard psychotherapy CPT codes for clinically appropriate mental health services for many years. Ultimately, reimbursement decisions are made by each insurance company according to the client’s individual policy, the provider’s contract, medical necessity, and applicable documentation requirements.
