ModifiedUnitedHealthcarePolicy N/A

Sensory Integration Therapy and Auditory Integration Training (for Ohio Only) – Community Plan Medical Policy

Defines UnitedHealthcare's interpretation and guidance for coverage of sensory integration therapy (SIT) and auditory integration training (AIT) for Ohio members, referencing Ohio Administrative Code Rule 5160-1-01 for medical necessity and noting use of InterQual and other criteria where applicable. Includes references and revision history updates.

Policy Summary

PayerUnitedHealthcare

PolicySensory Integration Therapy and Auditory Integration Training (for Ohio Only) – Community Plan Medical Policy

Policy CodePolicy N/A

Change TypeRevised guidance language; updated evidence/references

Effective DateFebruary 1, 2026

Next Review DateN/A

Key ActionProviders must evaluate SIT and AIT medical necessity using Ohio Administrative Code Rule 5160-1-01 and document support per that rule and any applicable InterQual® criteria.

SourceLink

POLICY UPDATE CHANGES

Replaced language indicating SIT and AIT should be evaluated for medical necessity using Ohio Administrative Code Rule 5160-1-01 with language to 'refer to' that Rule for medical necessity clinical coverage criteria for sensory integration therapy (SIT) and auditory integration training (AIT).

Updated Clinical Evidence and References sections to reflect the most current information; archived previous policy version CS108OH.D.

OAC 5160-1-01Medical necessity source

InterQual®Primary criteria engine

CS108OH.D archived

Coverage Summary

Defines UnitedHealthcare's interpretation and guidance for coverage of sensory integration therapy (SIT) and auditory integration training (AIT) for Ohio members, directing that medical necessity determinations reference Ohio Administrative Code Rule 5160-1-01 and use InterQual® criteria where applicable.

This policy applies only to Ohio and notes that the previous policy version CS108OH.D has been archived as part of recent revisions and updates to clinical evidence and references.

Policy key facts

Medical necessity sourceRefer to OAC Rule 5160-1-01

Primary criteria engineInterQual® primary

Previous version archivedCS108OH.D archived

Last review2026-02-01

Medical Necessity / Criteria Reference

Coverage Rationale / Medical Necessity Reference

Refer to the Ohio Administrative Code Rule 5160-1-01 for medical necessity clinical coverage criteria for SIT and AIT. Coverage decisions use InterQual® criteria when applicable.

ALL of the following

Coverage and medical necessity for sensory integration therapy (SIT) and auditory integration training (AIT) are determined by referencing Ohio Administrative Code, Rule 5160-1-01, Medicaid medical necessity: definitions and principles.
UnitedHealthcare uses InterQual® for primary medical/surgical criteria and ASAM for substance use; if InterQual® lacks applicable criteria, UnitedHealthcare may use its own Medical Policies, Coverage Determination Guidelines, or Utilization Review Guidelines approved by the Ohio Department for Medicaid Services.
In the event of conflict between this Medical Policy and federal, state (OAC), or contractual requirements, the federal/state/contractual requirements govern.

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Provider Actions / Requirements

Documentation Required

Follow Ohio OAC Rule 5160-1-01 for medical necessity

Providers must evaluate SIT and AIT medical necessity using Ohio Administrative Code Rule 5160-1-01; documentation should support medical necessity per that rule and any applicable InterQual® criteria.

Documentation should support medical necessity per OAC Rule 5160-1-01 and any applicable InterQual® criteria.

Documentation Required

Use InterQual and approved UnitedHealthcare guidelines when applicable

If InterQual® criteria apply, use them as the primary criteria; if InterQual® does not have applicable criteria, use UnitedHealthcare Medical Policies, Coverage Determination Guidelines, or Utilization Review Guidelines that are approved by the Ohio Department for Medicaid Services.

If InterQual® lacks applicable criteria, escalate to UnitedHealthcare Medical Policies, Coverage Determination Guidelines, or Utilization Review Guidelines approved by the Ohio Department for Medicaid Services.

Coding

No specific procedure/diagnosis/billing codes provided in this partmixed

No codes listed

Background & Evidence

This document is part of UnitedHealthcare's medical policy guidance for SIT and AIT specific to Ohio Medicaid members and emphasizes that medical necessity and coverage decisions should refer to Ohio Administrative Code, Rule 5160-1-01 and, when applicable, use InterQual® as the primary criteria engine.

Evidence summary

Clinical evidenceMultiple randomized controlled trials and systematic reviews are cited, including Cochrane and AHRQ comparative effectiveness reviews and RCTs such as the SenITA trial; evidence base includes mixed findings across RCTs and systematic reviews (e.g., Cochrane, AHRQ, SenITA RCT, and other RCTs), with limitations noted for small samples, heterogeneity, and risk of bias.

Definitions

Term	Definition
SIT	Sensory Integration Therapy
AIT	Auditory Integration Training
InterQual®	A clinical decision support criteria set used by UnitedHealthcare for medical/surgical criteria

Revision History

02/01/2026revision (non-material)Latest

Replaced language directing that SIT and AIT 'should be evaluated for medical necessity using' Ohio Administrative Code Rule 5160-1-01 with wording to 'refer to' that Rule for medical necessity clinical coverage criteria; updated Clinical Evidence and References sections; archived previous policy version CS108OH.D.

revision (non-material)

Archived previous policy version CS108OH.D and updated Clinical Evidence and References sections to reflect the most current information.