CurrentAetnaPolicy 0256

Sensory and Auditory Integration Therapy

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This policy addresses the coverage stance for sensory integration therapy (SIT) and auditory integration therapy (AIT) for persons with communication, behavioral, emotional, and learning disorders and for all other indications; it applies to Aetna's member population governed by this Clinical Policy Bulletin.

Policy Summary

PayerAetna

PolicySensory and Auditory Integration Therapy

Policy CodePolicy 0256

Change TypeNo material change

Effective DateMay 29, 1998

Last ReviewApr 26, 2023

Next Review DateMar 14, 2024

Key ActionDo not request authorization for SIT or AIT for listed indications because these therapies are considered experimental/investigational and are not supported as medically necessary.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

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CurrentAetnaPolicy 0256

Sensory and Auditory Integration Therapy

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Policy Summary

PayerAetna

PolicySensory and Auditory Integration Therapy

Policy CodePolicy 0256

Change TypeNo material change

Effective DateMay 29, 1998

Last ReviewApr 26, 2023

Next Review DateMar 14, 2024

Key ActionDo not request authorization for SIT or AIT for listed indications because these therapies are considered experimental/investigational and are not supported as medically necessary.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

experimentalcoverage stance for SIT and AIT

30 sessionsSchaaf 2014 dosage

2 trialsAIT positive trials

60references listed

05/29/1998policy effective

03/14/2024next review

Coverage Determination

Overall coverage determination

Experimental and Investigational

Policy determination: SIT and AIT are considered experimental and investigational for the management of persons with various communication, behavioral, emotional, and learning disorders and for all other indications.

Effectiveness is unproven per policy.

Coverage conclusions

Coverage determination based on evidence and guideline positions

AIT (Auditory Integration Training): AIT and other sound therapies are considered investigational/unproven due to insufficient and inconsistent evidence from small trials and systematic reviews; there is no reliable evidence to support routine coverage.

Cochrane and multiple systematic reviews conclude no evidence of effectiveness; professional organizations (AAA, AAP) consider AIT investigational.

Sensory Integration Therapy (SIT/ASI): Evidence for sensory integration approaches is mixed: some manualized SIT/ASI trials (e.g., Schaaf 2014) showed positive outcomes (GAS, self-care, socialization) after 30 sessions, and systematic reviews (Watling & Hauer 2015) found moderate evidence for ASI, but overall methodological limitations and heterogeneity mean additional rigorous trials are needed; coverage may be considered only when provided as part of a comprehensive treatment plan with documented manualized protocol and outcome measurement.

SIT may be acceptable as a component of comprehensive care when delivered with fidelity and objective outcome tracking.

Aetna considers sensory integration therapy (SIT) and auditory integration therapy (AIT) to be experimental and investigational for the management of persons with various communication, behavioral, emotional, and learning disorders and for all other indications. These therapies are excluded from coverage for the listed indications because their effectiveness is unproven and they are not supported as medically necessary services under this Clinical Policy Bulletin.

Interventions described as auditory integration training (AIT) or other sound-based therapies are considered investigational and are not supported for routine treatment of autism spectrum disorder (ASD). Systematic reviews and randomized trials have not provided reliable evidence of benefit for AIT, and professional statements and evidence syntheses cited in the policy conclude there is insufficient data to support routine clinical use.

Clinical Policy Bulletins are developed to assist in administering plan benefits and do not constitute offers of coverage or guarantees of payment. They provide a partial, general description of plan or program benefits; actual coverage is determined by the member's plan or program documents and applicable contractual terms.

Because SIT and AIT are categorized in this policy as experimental and investigational, they are not considered medically necessary for the indications listed in this Clinical Policy Bulletin and, accordingly, are not supported for coverage when billed for those indications.

AIT is specifically identified as not medically necessary for treatment of ASD given the lack of demonstrated, consistent benefit in the available trials and systematic reviews. The policy cites limited, small studies with heterogeneous outcomes and concludes there is insufficient evidence to support AIT as an effective treatment for ASD.

Billing Codes and Status

Prior Authorization

Provider actions and billing guidance

Prior authorization is recommended for Sensory Integration Therapy/Auditory Integration Therapy (SIT/AIT). Treating providers are responsible for obtaining any recommended prior authorization, documenting medical necessity, and submitting complete records to support claims. Evidence is insufficient for many indications and may trigger claim denial; payers may deny services lacking required documentation or that do not meet coverage criteria. Providers should pursue established, stepwise therapies before SIT/AIT when applicable (stepwise preference for established therapies).

Prior authorization recommended for SIT/AIT
Evidence insufficiency may trigger denial
Treating providers are responsible for medical necessity documentation and prior authorization
Stepwise preference for established therapies

Covered CPT CodesCPTCovered

97533

Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands; direct (one-on-one) patient contact by the provider, each 15 minutes.

ICD-10 Codes Not Covered for Indications ListedICD-10Not Covered

F43.20-F43.29	Adjustment disorders.
F80.9	Developmental disorder of speech and language, unspecified [communication disorder].
F81.0-F81.9	Specific developmental disorders of scholastic skills.
F84.0-F84.9	Pervasive developmental disorders.
F90.0-F90.9	Attention-deficit hyperactivity disorders.
F91.0-F91.9	Conduct disorders.
F93.0-F93.9	Emotional disorders with onset specific to childhood.
Q99.2	Fragile X chromosome.
R62.50	Unspecified lack of expected normal physiological development in childhood.
Z03.89	Encounter for observation for other suspected diseases and conditions ruled out [observation for suspected mental health condition].

Documentation Required

Coding and documentation guidance — CPT 97533 example and ICD-10 listing

Prior Authorization, Documentation, and Billing Guidance

Prior Authorization

Prior authorization expectation — SIT/AIT considered experimental/investigational

Prior authorization is unlikely to be granted because the policy states SIT and AIT are considered experimental and investigational and are not supported as medically necessary for the listed indications.

SIT and AIT are classified as experimental and investigational for management of communication, behavioral, emotional, and learning disorders.
Authorization is unlikely when these services are billed for the listed indications.

Prior Authorization

Prior authorization recommended — required documentation and protocol specifics

If seeking prior authorization for SIT or AIT, submit documentation of the member's diagnosis, how the therapy is part of a comprehensive treatment plan, the specific modality being proposed (AIT vs ASI/SIT), and the manualized protocol and planned outcome measures.

Provide evidence of confirmed diagnosis and indication that therapy complements a comprehensive, coordinated care plan.
Specify modality (AIT or ASI/SIT), include the manualized protocol, treatment fidelity measures, and planned objective outcomes.

Clinical Background

Sensory integration refers to the brain's process of organizing and interpreting stimuli from touch, movement, sight and sound. SIT typically involves therapeutic activities and use of equipment (for example, swings, balance or tactile tools, weighted items) delivered by occupational or physical therapists to promote adaptive responses. AIT (also called auditory integration training) and other sound therapies involve modification of listening input (filtered or modulated sounds/music) intended to alter auditory processing. Both SIT and AIT have been evaluated for autism spectrum disorders and other developmental conditions, but the policy concludes evidence is limited, heterogeneous, and insufficient to demonstrate consistent clinical benefit.

Key Terms

inv-24: Sensory integration therapy (SIT) — definition and typical providers/interventions

DefinitionSensory integration therapy (SIT): treatment usually performed by occupational therapists or physical therapists providing various sensory stimulation combined with purposeful activities to improve how the brain processes and organizes sensory information.

Typical providersOccupational therapists or physical therapists deliver SIT interventions.

Typical activities/equipmentFull-body movement activities using equipment such as textured mitts, carpet squares, scooter boards, ramps, swings, and bounce pads to provide tactile, vestibular, and proprioceptive input.

Therapeutic goalEnhance sensory processing abilities so the individual can acquire higher-level skills (rather than directly teaching those skills).

Common indications studiedApplied for children with autism spectrum disorder, attention-deficit disorder, fragile X syndrome, developmental delay, and learning/behavioral disorders, though effectiveness is uncertain.

Therapies Addressed

SIT and AIT

Modalities discussed: Sensory integration therapy (occupational/physical therapy approaches using equipment and movement activities) and auditory integration training/sound therapies (filtered/modulated listening) are described; evidence is cited as limited and mixed with systematic reviews concluding insufficient evidence of efficacy for ASD and other disorders.

Multiple systematic reviews and RCTs summarized.

Sensory Integration / Ayres Sensory Integration (ASI)

Manualized ASI/SIT: When ASI/SIT is provided, it should use a manualized protocol with documented treatment fidelity and objective outcome measures (e.g., GAS).

Schaaf 2014 used 30 sessions and demonstrated GAS improvements but recommends replication in larger samples.

Auditory Integration Training (AIT)

Session Dosing and Visit Examples

inv-33: Sensory integration interventions (research study dosing) — example: 3 sessions/week for 6 weeks

Example study dosingPilot RCT example: 3 sessions per week for 6 weeks (intense short-term intervention used in Pfeiffer et al's pilot study).

Purpose of dosing noteAuthors recommended future studies determine optimal frequency and duration; short intense dosing was used to guide future RCT design.

Fidelity recommendationUse of fidelity measures and development of intervention manuals was recommended to ensure consistency in future trials.

inv-34: manualized occupational therapy using sensory integration (Schaaf 2014) — 30 sessions noted

Trial dosingSchaaf et al (2014) provided 30 sessions of a manualized occupational therapy intervention using sensory integration for children with autism (ages 4–8).

Outcomes reported

Policy Reviews and References

Note

Revision/history note — verify current CPB version and plan amendments

Refer to plan records for revision- or history-specific provider notes; CPBs may be updated and providers should confirm the current version and any plan amendments before acting.

The CPB may be updated and is subject to change; verify last review and effective dates via plan resources.
Providers should consult plan disclosures for any revision-specific obligations.

Policy Summary

PayerAetna

PolicySensory and Auditory Integration Therapy

Policy CodePolicy 0256

Change TypeNo material change

Effective DateMay 29, 1998

Last ReviewApr 26, 2023

Next Review DateMar 14, 2024

Key ActionDo not request authorization for SIT or AIT for listed indications because these therapies are considered experimental/investigational and are not supported as medically necessary.

SourceLink

On This Page

Example coding and documentation guidance: CPT 97533 should be used for sensory integrative techniques provided one-on-one by the provider, billed in 15-minute units. Ensure documentation includes the therapeutic rationale, specific techniques used, time spent (face-to-face), measurable treatment goals, response to treatment, and justification that established therapies were attempted or considered prior to SIT/AIT when applicable. Failure to document medical necessity or prior authorization when recommended may lead to claim denial.

Prior Authorization

Prior authorization requirement — follow plan processes and CPB references

Follow the member's plan-specific prior authorization processes and Clinical Policy Bulletin references when requesting authorization; plan provisions and program disclosures govern coverage decisions.

Use the plan's prior authorization procedures as outlined in member plan disclosures and program provisions.
Clinical Policy Bulletins assist administration but do not guarantee coverage.

Note

Provider action — consult plan disclosures for applicability

When interacting with plan prior authorization or claims staff, note that the CPB emphasizes plan-specific application; providers should consult member plan disclosures for definitive guidance.

CPBs provide partial descriptions of plan or program benefits and are not contracts or coverage guarantees.
Providers are responsible for verifying applicable plan provisions.

Step Therapy

Stepwise preference — prioritize established OT with sensory-based approaches

Consider established occupational therapy approaches (including sensory-based OT delivered as part of a comprehensive program) before less-supported modalities like AIT; unsupported therapies should be reserved for experimental contexts.

AAP notes SIT should be integrated with educational and medical treatment plans and individualized.
Manualized occupational therapy using sensory integration showed benefit in one trial (30 sessions) but requires replication; use established therapies first.

Note

Provider action — verify plan-specific guidance

Refer to the member's plan and CPB notes for any plan-specific provider guidance and program provisions before initiating services.

Clinical Policy Bulletins are not coverage guarantees; verify plan terms and any program-specific requirements.
Contact plan prior authorization resources as needed for plan-specific instructions.

Documentation Required

Documentation to support clinical benefit — protocol, fidelity, sessions, outcomes

Document any sensory integration intervention using a manualized protocol, evidence of treatment fidelity, the number and frequency of sessions provided (e.g., 30 sessions described in Schaaf 2014), and objective outcome measures.

Include the manualized protocol and measures of treatment fidelity.
Record session counts and frequency (trial example: 30 total sessions) and use objective outcomes (e.g., GAS, caregiver assistance, socialization measures).

Documentation Required

Provider responsibility — follow plan documentation expectations and disclosures

Providers are responsible for medical advice and treatment; documentation expectations and any plan-program requirements are available via the plan's disclosures and CPB additional information links.

Treating providers are independent and responsible for clinical care decisions.
Consult plan disclosures and program provisions for documentation and administrative requirements.

Denial Risk

Denial risk — experimental/investigational therapies may be denied

Therapies designated experimental and investigational under this policy may be denied as not covered when billed for the CPB-listed indications.

SIT and AIT are considered experimental/investigational and not medically necessary for listed indications; claims may be denied on that basis.

Denial Risk

Denial risk — evidence insufficiency for AIT may trigger claim denials

Because AIT and other sound therapies lack consistent supporting evidence in trials and reviews, claims for AIT may be denied due to insufficient evidence of effectiveness.

Systematic reviews identified small, heterogeneous trials with inadequate allocation concealment and inconsistent outcomes, leading to the conclusion that there is no evidence to support routine use of AIT.

Denial Risk

Adverse-outcome concern — reports of increased psychiatric risk after SIT in ADHD

Note potential adverse-outcome reports: one population-based study found an increased incidence of subsequent psychiatric disorders among children with ADHD who received SIT, which payers may consider when evaluating coverage and safety.

Tzang et al (2019) reported an adjusted hazard ratio of 1.41 for subsequent psychiatric disorders in children with ADHD who received SIT versus those who did not.
Potential adverse effects should be examined and discussed prior to practice.

Note

Provider-facing disclaimer — CPBs do not guarantee coverage

Clinical Policy Bulletins are tools to assist plan administration and do not constitute coverage guarantees; absence of a guarantee may affect authorization and claims decisions.

CPBs contain only partial descriptions of plan benefits and do not constitute a contract.
Coverage is determined by applicable plan or program provisions referenced in member disclosures.

inv-25: Auditory integration therapy (AIT) — definition and sound-modification description

DefinitionAuditory integration therapy (AIT) / auditory integration training: sound-modification therapies that use filtered, modulated, or altered music/listening inputs intended to change auditory processing.

Typical technique describedModification of music or sound (e.g., filtering or modulation) presented to the patient as a therapeutic auditory stimulus.

Professional viewConsidered experimental by professional bodies (American Speech-Language-Hearing Association; American Academy of Pediatrics recommended for research only) due to lack of demonstrated efficacy.

Evidence summary noteA number of assessments and reviews (Wessex, Cullen et al, National Initiative for Autism) have concluded conflicting or no greater benefit than placebo for AIT.

inv-26: SI/SP-T — sensory integration / sensory processing treatment equipment and materials

DefinitionSI/SP-T (sensory integration / sensory processing treatment): a set of procedures and materials aimed at improving tactile, proprioceptive, and vestibular processing using structured sensory protocols.

Equipment/devicesLycra swings, balance beams, climbing walls, trampolines, weighted vests, and sensory brushes are examples of SI/SP-T equipment.

Activities/materialsActivities include placing hands in messy substances (e.g., shaving cream), sequenced movements, and other tactile/proprioceptive exercises that provide varied sensory input.

Implementation noteInterventions may include incidental behavioral facilitators (e.g., contingent verbal models) that should be controlled for when testing unique effects of sensory-based interventions.

inv-27: Auditory Integration Training (AIT) — definition and evidence conclusion

DefinitionAuditory Integration Training (AIT): sound-based therapy intended to improve auditory processing by presenting modified auditory stimuli (e.g., filtered/modulated music).

Evidence conclusionSystematic reviews and trial summaries identify 7 trials (182 participants) with inconsistent results; overall conclusions state there is no reliable evidence to support AIT for ASD and related indications.

Trial limitationsMost trials were small (many <20 participants), had inadequate allocation concealment, disparate outcome measures, and high heterogeneity preventing meta-analysis.

inv-28: Auditory and sensory integration therapies — ASDs and developmental conditions context

Context — target conditionsAuditory and sensory integration therapies have been studied as interventions for autism spectrum disorder (ASD), ADHD, learning disabilities, fragile X syndrome, and other developmental/behavioral conditions.

Policy stance summaryProfessional assessments and systematic reviews have characterized these therapies as experimental/investigational or unproven for routine treatment of ASD and other developmental conditions.

Research considerationsResearch reviews emphasize methodological limitations, heterogeneous outcome measures, and the need for manualized protocols and rigorous trials to establish efficacy.

Auditory Integration Training (AIT): AIT is investigational and lacks consistent supportive evidence; professional bodies consider it investigational and recommend further research.

Multiple systematic reviews and professional statements (AAA, AAP, Cochrane) do not support routine use.

Sensory integration / Auditory integration

Evidence and references: Document cites multiple systematic reviews, randomized trials, and professional statements regarding auditory integration training and sensory integration interventions for autism spectrum disorder and other developmental conditions.

See references list for systematic reviews (e.g., Sinha 2006; Watling & Hauer 2015) and primary trials (e.g., Schaaf 2014).

The trial showed significant improvements on Goal Attainment Scaling (GAS) and measures of caregiver assistance in self-care and socialization compared with usual care.

Study rigor noteStudy used a manualized protocol and measured treatment fidelity; authors cautioned that replication in larger samples is needed.