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.
No material clinical or coverage changes in this revision.
Coverage Determination
Overall coverage determination
Experimental and Investigational
Effectiveness is unproven per policy.
Coverage conclusions
Coverage determination based on evidence and guideline positions
Cochrane and multiple systematic reviews conclude no evidence of effectiveness; professional organizations (AAA, AAP) consider AIT investigational.
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
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
| 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. |
| 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]. |
Coding and documentation guidance — CPT 97533 example and ICD-10 listing
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, Documentation, and Billing Guidance
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 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.
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.
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.
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.
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 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).
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 — 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 — 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.
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.
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.
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
Therapies Addressed
SIT and AIT
Multiple systematic reviews and RCTs summarized.
Sensory Integration / Ayres Sensory Integration (ASI)
Schaaf 2014 used 30 sessions and demonstrated GAS improvements but recommends replication in larger samples.
Auditory Integration Training (AIT)
Multiple systematic reviews and professional statements (AAA, AAP, Cochrane) do not support routine use.
Sensory integration / Auditory integration
See references list for systematic reviews (e.g., Sinha 2006; Watling & Hauer 2015) and primary trials (e.g., Schaaf 2014).
Session Dosing and Visit Examples
Policy Reviews and References
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.
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