CurrentColorado Rocky Mountain Health PlansPolicy 2026T0314CC

Sensory Integration Therapy and Auditory Integration Training

This policy governs coverage and medical necessity determination for Sensory Integration Therapy (SIT) and Auditory Integration Training (AIT) for UnitedHealthcare Commercial and Individual Exchange benefit plans.

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicySensory Integration Therapy and Auditory Integration Training

Policy CodePolicy 2026T0314CC

Change TypeMinor — no material clinical or coverage changes

Effective DateJan 1, 2026

Next Review Date

Key ActionCheck member-specific benefit and prior authorization requirements before providing services; SIT and AIT are described as unproven and not medically necessary.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

2therapies declared not medically necessary

97533CPT code referenced

9RCTs in Acuña review

4AIT small RCTs

2SIT positive GAS RCTs

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06/01/2026policy history date

Coverage Determination

inv-01: Not Medically Necessary — SIT and AIT

Covered when ALL of the following are met:

Primary coverage determination: Sensory integration therapy (SIT) and auditory integration training (AIT) are considered unproven and not medically necessary for treating any condition due to insufficient evidence of efficacy.

Services for SIT and AIT are subject to denial as not medically necessary.

inv-02: Evidence-based coverage considerations

Summary of evidence and implications for coverage decisions:

SIT evidence summary: Randomized and nonrandomized studies and systematic reviews report some positive outcomes (for example, Goal Attainment Scaling, motor skills, and selected sensory-related outcomes) but the evidence is limited by small sample sizes, short follow-up, lack of blinding, variable or nonmanualized protocols, and heterogeneous interventions, reducing confidence in sustained clinical benefit.

See Case-Smith 2015, Weitlauf et al. 2017, Kashefimehr et al. 2018; additional rigorous trials are needed.

AIT evidence summary: AIT/TOMATIS and related sound-based therapies have limited published literature that is small, heterogeneous, and inconsistent; professional organizations and guidance documents have characterized AIT as investigational or not recommended because evidence is insufficient to demonstrate efficacy and safety.

See AHRQ reviews and professional statements referenced in policy.

No indications for Sensory Integration Therapy (SIT) or Auditory Integration Training (AIT) are listed as covered. The policy states that both SIT and AIT are unproven and not medically necessary for treating any condition due to insufficient evidence of efficacy.

National guidance from NICE (Clinical Guideline CG170, updated 2021) specifically recommends that auditory integration training should not be used to manage speech and language problems in children and young people with autism.

Additional contextual sources cited in the policy include randomized trials, systematic reviews, professional practice guidelines, and clinical trials registries that evaluate sensory integration and sound-based interventions. These references encompass pilot RCTs, cohort studies, and guideline statements which informed the coverage determination and are available in the policy reference list for detailed review.

The policy concludes SIT and AIT are unproven because available studies are small, heterogeneous, and methodologically limited. Published RCTs and reviews report mixed results, with some small trials suggesting possible benefits but larger or higher-quality studies (for example the SenITA RCT) failing to show consistent, clinically meaningful improvements; design limitations such as short follow-up, lack of assessor masking, variable protocols, and potential for bias reduce confidence in efficacy.

Major professional organizations have concluded AIT is investigational. The American Academy of Audiology (2010) states AIT is investigational and calls for prospective, systematic research to demonstrate efficacy. The American Speech-Language-Hearing Association (ASHA, 2004) reported that AIT had not met scientific standards for efficacy and safety to be considered a mainstream treatment.

Applicable Codes

Applicable CPT Codes (reference)CPT

97533

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

Provider Requirements and Administration Notes

Prior Authorization

Prior Authorization (informational)

Prior authorization may be required by some benefit plans. This is informational — check the member's specific benefit plan for prior authorization requirements before scheduling services.

Verify prior authorization requirements with the member's plan prior to service delivery.
If prior authorization is required, submit clinical documentation demonstrating medical necessity per the member-specific benefit plan.

Denial Risk

Not medically necessary — SIT and AIT

Sensory integration therapy (SIT) and auditory integration training (AIT) are considered unproven and not medically necessary due to insufficient evidence of efficacy. Requests for coverage of SIT or AIT should be expected to be denied unless overridden by member-specific plan language.

Document clinical rationale if requesting an exception and reference supporting clinical evidence.

Clinical and Evidence Background

Sensory Integration Therapy (SIT) is intended to improve processing and integration of vestibular, proprioceptive, and tactile inputs to enhance sensorimotor skills. It is commonly provided by occupational therapists using activities and equipment (for example swings, weighted items, or scooter boards) delivered over repeated sessions to address individualized functional goals.

Key Definitions

Sensory Integration Therapy (SIT) — definition and features

DefinitionTherapy combining vestibular, proprioceptive, and tactile stimulation during individualized OT sessions (typically 60–90 minutes) to elicit adaptive motor responses and improve sensorimotor skills

Typical deliveryProvided by an occupational therapist in 1–3 sessions per week over several months to years using activities and equipment (e.g., swings, scooter boards, weighted vests)

Therapeutic elementsUses vestibular, proprioceptive, and tactile inputs embedded in play and motor activities to encourage noncognitive, creative, explorative processing

Common equipmentTextured mitts, carpets, scooter boards, ramps, swings, bounce pads, suspended equipment, weighted vests and blankets

Auditory Integration Training (AIT) — definition and protocol summary

Definition/Protocol

Policy History

2026-06-01policy_effective_or_revisionLatest

Policy version effective 2026-01-01 and shared policy creation for Oxford plan noted; latest administrative update recorded 2026-06-01.

2026-01-01policy_adoption

Creation of a shared policy version for the Oxford plan effective 2026-01-01 as part of transition to the 2026 policy cycle.

2025-07-29literature_update

Policy Summary

PayerColorado Rocky Mountain Health Plans

PolicySensory Integration Therapy and Auditory Integration Training

Policy CodePolicy 2026T0314CC

Change TypeMinor — no material clinical or coverage changes

Effective DateJan 1, 2026

Next Review Date

Key ActionCheck member-specific benefit and prior authorization requirements before providing services; SIT and AIT are described as unproven and not medically necessary.

SourceLink

On This Page

Be aware of provider-facing denial risk for SIT and AIT services.

Note

Device/Regulatory Note

The equipment used for sensory integration therapy and auditory integration training is not considered medical in nature and is not regulated by the U.S. Food and Drug Administration (FDA). This information is for reference only and does not determine coverage.

Do not assume FDA clearance/approval for SIT/AIT equipment implies coverage.
Refer to member-specific plan language for durable medical equipment or supply coverage determinations.

Documentation Required

Coding and documentation note — submit appropriate procedure codes and supporting clinical documentation

Submit appropriate procedure codes and complete supporting clinical documentation to justify the service. Listing of a code in policy is informational and does not guarantee coverage. Always document assessment, goals, intervention details, frequency/duration, and measurable outcomes.

Include objective measures and baseline data in the record (e.g., functional assessments).
Attach progress notes, treatment plans, and any standardized outcome measures used.
Ensure coding reflects the actual services provided and supports medical necessity.

Note

Outcome Measurement — Goal Attainment Scaling when ASI used for individualized goals

When ASI is used to address individualized goals, outcome measurement such as Goal Attainment Scaling (GAS) should be used to document goal-specific progress. Use validated, objective measures where available and document results at baseline and at defined intervals.

Record baseline GAS scores and subsequent attainment levels to demonstrate progress.
Include other standardized measures where applicable (functional, behavioral, quality-of-life).

Documentation Required

Documentation of benefit verification — reference member benefit and document rationale

Verify member benefits and document the benefit determination in the medical record and prior authorization submission. Coverage decisions must reference the member-specific benefit plan; in case of conflict, the member plan governs.

Document the member-specific benefit plan reviewed, effective dates, and any applicable state or federal mandates.
If benefits do not cover SIT/AIT, include that rationale in denial or appeal documentation.

Note

Therapy Integration — guidance on inclusion within other therapies/educational settings

Sensory-based interventions may be incorporated within motor/behavioral therapies and educational settings per clinical guidelines, but inclusion does not equate to coverage. When integrating therapy, clearly document how sensory interventions are part of a broader, evidence-based treatment plan and how they address functional goals.

Describe how sensory activities are integrated into occupational therapy, behavioral therapy, or educational plans.
Link sensory intervention goals to functional outcomes and measurable objectives (e.g., via GAS).

AIT (e.g., Berard AIT) requires listening to modulated music via a specific device using high‑quality headphones for a total of about 10 hours over 10–12 consecutive days under supervision

Intended purposeDeveloped to improve abnormal sound sensitivity in individuals with behavioral disorders or autism spectrum disorder

Evidence/standardizationPublished literature is limited; protocols have not been standardized and older RCTs are inconsistently supportive of benefit

Safety noteSafety concerns include potential distress and/or hearing damage reported by professional bodies

Ayres Sensory Integration (ASI) — manualized OT approach

DefinitionA manualized occupational therapy approach (Ayres Sensory Integration®) that targets individualized sensory‑processing and functional goals

Outcome measurementWhen used for individualized goals, measurement by Goal Attainment Scaling is an evidence‑supported outcome measure per AOTA guidance

Evidence grading (AOTA)ASI included in practice guideline with B‑moderate to C/I evidence across different outcome areas (e.g., occupational performance, sensory processing)

AIT / TOMATIS — sound‑based therapies and protocol variability

DefinitionSound‑based therapies (e.g., Berard AIT, TOMATIS®) aiming to alter auditory processing and related behavior

Protocol variabilityTreatment protocols vary widely between systems and studies (duration, session frequency, device used) and have not been standardized

Recent studiesTOMATIS studies report mixed results (e.g., Fu et al. 2024 showed improvements in a small cross‑sectional/longitudinal sample) but require independent confirmation

Regulatory/evidence concernsProfessional reviews note limited, uncontrolled studies and small trials; efficacy and safety have not been demonstrated in larger standardized trials

Sensory integration therapy (including Ayres Sensory Integration® and sensory‑based interventions) — general definition

Broad definitionTherapeutic interventions aiming to address sensory‑processing challenges to improve functional outcomes across populations (children with ASD, developmental disorders, etc.)

Scope of interventionsIncludes manualized ASI, sensory‑based interventions, multisensory activities, environmental modifications, and sound therapies

Evidence baseEvaluated in randomized trials, systematic reviews, practice guidelines and referenced literature with mixed and often limited quality evidence

Guideline positioningClinical guidelines (AOTA, AAP, NICE) and systematic reviews note variable evidence; some interventions rated insufficient or not recommended for certain outcomes

References and guideline sources (including updated NICE guidance and multiple recent trials/reviews) were accessed or cited as of July 29, 2025 to inform the evidence review.

2024-06-?evidence_publication

AOTA practice guideline update (Tomchek & Koenig) and other systematic reviews and trials published or reaffirmed in 2023–2024 were included in evidence considerations.

2010-01-01professional_body_position

American Academy of Audiology position (2010) concluded AIT is investigational; cited as basis for considering AIT not proven/not medically necessary.

2004-01-01professional_body_position

American Speech-Language-Hearing Association technical report (2004) found insufficient evidence for AIT efficacy, supporting investigational status.