CurrentUnitedHealthcarePolicy CS108TN.N

Sensory Integration Therapy and Auditory Integration Training (for Tennessee Only)

Defines UnitedHealthcare's Tennessee-specific policy direction for sensory integration therapy and auditory integration training for members covered by TennCare Medicaid and Tennessee CoverKids; instructs readers to defer to referenced TennCare and CoverKids exclusion chapters for medical necessity criteria.

Policy Summary

PayerUnitedHealthcare

PolicySensory Integration Therapy and Auditory Integration Training (for Tennessee Only)

Policy CodePolicy CS108TN.N

Change TypeReplaced internal coverage guidelines with referral to state regulations

Effective Date01/01/2026

Next Review Date

Key ActionFollow TennCare and CoverKids regulations for coverage determination and any prior authorization requirements.

SourceLink

POLICY UPDATE CHANGES

Replaced internal coverage guidelines with instruction to refer to TennCare Medicaid and CoverKids regulations for medical necessity clinical coverage criteria.

1CPT code listed

TennesseeState

2Referenced chapters

01/01/2026Effective

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Coverage Determination (State Regulations)

Coverage determined by TennCare/CoverKids regulations

Coverage and medical necessity are determined by referenced Tennessee regulations:

State regulation referral: Medical necessity clinical coverage criteria for sensory integration therapy and auditory integration training are determined by TennCare Medicaid Chapter 1200-13.13-.10 (for TennCare) and CoverKids Chapter 1200-13-21-.06 plus TennCare Chapter 1200-13.13-.10 (for CoverKids).

Providers must consult those regulatory chapters for specific coverage criteria.

Refer to the applicable Tennessee regulations for definitive coverage and medical-necessity determinations. For members covered by TennCare Medicaid, consult TennCare Medicaid, Chapter 1200-13.13-.10: Exclusions. For members covered by Tennessee CoverKids, consult CoverKids, Chapter 1200-13-21-.06: Exclusions and TennCare Medicaid, Chapter 1200-13.13-.10: Exclusions as applicable.

This policy removes the prior internal "Not Medically Necessary" language and instead directs users to state regulatory chapters for medical necessity determinations. See the policy revision noting that coverage guidelines were replaced with instructions to refer to the relevant TennCare and CoverKids exclusion chapters.

Provider Requirements and Denial Risk

Prior Authorization

Follow TennCare/CoverKids PA rules — prior authorization and coverage governed by referenced state regulations

Follow TennCare and CoverKids prior authorization and coverage rules. Prior authorization and coverage are governed by the referenced Tennessee state regulations; providers must obtain any required authorizations before delivering services.

Check applicable state plan and program rules before billing
Obtain and document prior authorization when required

Documentation Required

Provider documentation and billing expectations

Document clinical necessity and therapist qualifications clearly in the medical record. Include therapy goals, progress notes, frequency and duration, and evidence that services are addressing functional deficits.

Include specific functional deficits and measurable goals in documentation
Record therapist credentials and service modality for each encounter

Denial Risk

Denial risk tied to state regulations — claims should follow TennCare and CoverKids exclusion chapters

Claims for sensory integration therapy or auditory integration training may be denied if they do not meet TennCare or CoverKids exclusion criteria. Providers should follow the referenced state exclusion chapters when submitting claims to avoid denials.

Denials may occur if services fall under state-defined exclusions
Submit supporting documentation demonstrating medical necessity per state rules

Clinical Background

Sensory integration therapy and auditory integration training are interventions intended to address sensory processing and auditory processing concerns by using therapeutic techniques and non‑medical equipment to promote adaptive responses to environmental demands. UnitedHealthcare’s Tennessee policy clarifies that clinical coverage determinations for these interventions are made under state rules rather than internal criteria; the policy also indicates that sections describing the services and clinical evidence were removed in the most recent revision and previous policy versions were archived.

Key Definitions and Equipment Status

inv-10: 97533 (CPT) — definition for sensory integrative techniques

Code97533

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

Code systemCPT

Usage noteListing of a code in this policy is for reference only and does not by itself imply coverage or reimbursement

inv-11: Equipment regulatory status — equipment not considered medical in nature

Regulatory statusEquipment used for sensory integration therapy and auditory integration training is not considered medical in nature

FDA regulationBecause the equipment is not considered medical in nature, it is not regulated by the U.S. Food and Drug Administration (FDA)

GuidanceFDA approval alone is not a basis for coverage; equipment regulatory status is informational only