ModifiedUnitedHealthcarePolicy CS108NE.O

Sensory Integration Therapy and Auditory Integration Training (Nebraska Only)

This medical policy governs the medical necessity and coverage stance for sensory integration therapy and auditory integration training in Nebraska; it states these interventions are unproven and not medically necessary for treating any condition under this policy.

Policy Summary

PayerUnitedHealthcare

PolicySensory Integration Therapy and Auditory Integration Training (Nebraska Only)

Policy CodePolicy CS108NE.O

Change TypeClarified supporting information and references

Effective DateDecember 1, 2025

Next Review DateN/A

Key ActionVerify plan-specific prior authorization rules and note that SIT and AIT are designated unproven and not medically necessary for Nebraska members.

SourceLink

POLICY UPDATE CHANGES

Supporting Information: Updated Clinical Evidence and References sections to reflect the most current information; previous policy version archived (CS108NE.N).

1state-specific (NE)

97533example CPT listed

9RCTs in review

Do not useNICE stance (under-19s)

Investigational

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Coverage Determinations

Not medically necessary

Not covered — the following interventions are considered unproven and not medically necessary for treating any condition.

ALL of the following

Interventions
- Sensory integration therapy (SIT)
- Auditory integration training (AIT)

Sensory integration therapy (SIT) and auditory integration training (AIT) are considered unproven and not medically necessary for treating any condition under this policy due to insufficient evidence of efficacy.

The National Institute for Health and Care Excellence (NICE) guidance for support and management of autism spectrum disorder in patients under 19 years states that auditory integration training should not be used to manage speech and language problems in children and young people with autism.

The American Academy of Audiology (AAA) 2010 position statement concluded that AIT (by any name) is investigational and that prospective, systematic research is needed to demonstrate its efficacy.

The policy rationale summarizes the evidence base as insufficient to support routine coverage: randomized and controlled studies are limited and heterogeneous, and major expert bodies have characterized AIT and related sensory integration approaches as investigational or not recommended. As a result, these interventions lack the demonstrated clinical efficacy required for medical necessity determinations.

Major professional organizations and guideline bodies share a cautious stance: the American Academy of Audiology describes AIT as investigational; the American Speech-Language-Hearing Association found the method has not met scientific standards for efficacy and safety to be considered mainstream; and NICE recommends that AIT not be used for speech and language problems in people under 19 with autism.

Applicable Codes

Applicable 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 Responsibilities and Billing Guidance

Prior Authorization

Prior Authorization and Coverage Stance (Nebraska)

Prior authorization and medical necessity determinations for members in Nebraska should follow the state-specific policy: Sensory integration therapy (SIT) and auditory integration training (AIT) are considered unproven and not medically necessary. Providers must verify plan-specific prior authorization requirements with UnitedHealthcare before scheduling services.

Applicable to Nebraska members only
Confirm prior authorization requirements with the member's plan prior to service

Denial Risk

Not Medically Necessary — Denial Risk

Claims for sensory integration therapy (SIT) and auditory integration training (AIT) are at high risk for denial because these services are designated unproven and not medically necessary. Submit clear documentation when billing, but expect coverage denials for these services under UnitedHealthcare Nebraska plans unless state or contractual terms explicitly require otherwise.

Definitions and Background

Sensory Integration Therapy (SIT) is an occupational therapy approach that combines vestibular, proprioceptive, and tactile stimulation with motor activities to improve sensory processing and adaptive motor responses; sessions are typically individualized and may last about 60–90 minutes and use equipment such as swings, ramps, and weighted items. Auditory Integration Training (AIT) involves supervised sessions of listening to modulated or altered sounds (for example, protocols such as Berard AIT) delivered via headphones over multiple sessions with the intent of reducing abnormal sound sensitivity.

Sensory Integration Therapy (SIT) — definition and key attributes

TermSensory Integration Therapy (SIT)

DefinitionTherapy provided by occupational therapists combining vestibular, proprioceptive, and tactile stimulation with motor activities to improve sensory processing and adaptive motor responses.

Typical sessionIndividual OT session typically lasting 60–90 minutes using activities and equipment (e.g., swings, ramps, weighted items) to elicit adaptive motor responses.

Intended outcomesImprove perception and integration of sensory information to enhance sensorimotor skills, behavior, and academic performance (theoretical).

Policy Revision History

2025-12-01Policy revisionLatest

Updated Clinical Evidence and References sections; previous policy version CS108NE.N archived.

Policy Summary

PayerUnitedHealthcare

PolicySensory Integration Therapy and Auditory Integration Training (Nebraska Only)

Policy CodePolicy CS108NE.O

Change TypeClarified supporting information and references

Effective DateDecember 1, 2025

Next Review DateN/A

Key ActionVerify plan-specific prior authorization rules and note that SIT and AIT are designated unproven and not medically necessary for Nebraska members.

SourceLink

On This Page

Denial risk for SIT/AIT claims
Provide comprehensive clinical justification if pursuing coverage

Note

Regulatory Status May Affect Coverage

Equipment and devices used for SIT and AIT are not considered medical devices and are not regulated by the U.S. Food and Drug Administration (FDA). Regulatory status may affect coverage determinations and reimbursement policies.

Devices/equipment for SIT/AIT are not FDA-regulated
Regulatory non-medical status can influence coverage decisions

Documentation Required

Code Listing and Documentation Note

The codes listed in the policy (e.g., CPT 97533) are provided for reference only and do not imply coverage. Inclusion of a code does not guarantee reimbursement. Thorough documentation of services, clinical rationale, and any supporting evidence is required when submitting claims.

Reference code example: CPT 97533 — Sensory integrative techniques, each 15 minutes
Listing of a code does not imply the service is covered
Document services thoroughly to support medical necessity if requested

Note

Plan Terms and Documentation Requirements

Review the member's federal, state, and contractual benefit terms to determine applicable coverage and documentation requirements. UnitedHealthcare's Medical Policies are informational; actual benefit coverage is governed by the member's plan documents and any applicable state mandates.

Reference member-specific benefit terms before rendering services
UnitedHealthcare policies assist interpretation but do not override contractual terms

ProviderDelivered by an occupational therapist (OT).

Auditory Integration Training (AIT) — definition (Berard protocol example)

TermAuditory Integration Training (AIT)

Example protocolBerard AIT protocol: participant listens to modulated music via high-quality headphones for a total of 10 hours over 10 or 12 consecutive days under supervision of a trained AIT practitioner.

Indication describedDeveloped to improve abnormal sound sensitivity in individuals with behavioral disorders or autism spectrum disorders.

DeliveryDelivered using a specific device and supervised by a professionally trained AIT practitioner.

Ayres Sensory Integration (ASI) — definition and AOTA evidence grade

TermAyres Sensory Integration (ASI)

DefinitionAn occupational therapy approach to address individualized sensory processing and motor goals, using goal-directed activities measured by Goal Attainment Scaling.

AOTA evidence gradingAOTA grades ASI as B (moderate) evidence for addressing individualized goal areas measured by Goal Attainment Scaling; other ASI outcomes have weaker evidence (C, D, or I for insufficient).

ContextIncluded among sensory interventions and multisensory activities in AOTA practice guideline for individuals with ASD (Tomchek et al., 2016; reaffirmed 2024).

Auditory Integration Training (AIT) / TOMATIS — sound-based therapies summary

TermSound-based therapies (AIT / TOMATIS)

DefinitionInterventions using modulated or specific auditory stimulation (examples: Berard AIT, TOMATIS) intended to modify auditory processing and address sound sensitivity.

Evidence summaryLiterature is limited and heterogeneous with small, uncontrolled studies and some small RCTs; older RCTs do not consistently support benefit and protocols are not standardized.

Safety and research notesSafety concerns reported (may cause distress and/or hearing damage); larger, well-designed trials with standardized protocols are lacking and further research is needed.