CurrentUnitedHealthcarePolicy CS108PA.N

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

UnitedHealthcare Community Plan medical policy for Pennsylvania only addressing coverage and medical necessity of Sensory Integration Therapy (SIT) and Auditory Integration Training (AIT), summarizing evidence, guideline positions, and applicable procedure codes. This is Part 1 of 2 and contains rationale, literature review, guidance statements, and one referenced CPT code.

Policy Summary

PayerUnitedHealthcare

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

Policy CodePolicy CS108PA.N

Change TypeSupporting information updates

Effective DateDec 1, 2025

Next Review Date

Key ActionThis medical policy only applies to the state of Pennsylvania; providers should refer to the Pennsylvania Code, Title 55, Chapter 1101 and applicable federal/state/contractual benefit terms when deciding coverage.

SourceLink

POLICY UPDATE CHANGES

Updated Clinical Evidence and References sections to reflect the most current information; archived previous policy version CS108PA.M.

2Therapies declared not medically necessary

1Referenced CPT code

References updatedPolicy Update

Part 2 of 2Document Part

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Coverage Summary

UnitedHealthcare Community Plan medical policy for Pennsylvania (Policy Number: CS108PA.N) addressing Sensory Integration Therapy (SIT) and Auditory Integration Training (AIT), effective December 1, 2025. This policy (Part 1 of 2) summarizes evidence, guideline positions, and references one applicable CPT code (97533) for reference only. The policy status is CURRENT and the documented policy update on 12/01/2025 notes supporting information updates only.

Coverage stance: these therapies are declared not covered / not medically necessary for the indicated uses as summarized below. Headline stats: 2 therapies declared not medically necessary; 1 referenced CPT code; References updated; Document Part: Part 2 of 2.

Policy metadata

Effective DateDecember 1, 2025

Policy NumberCS108PA.N

Document PartPart 2 of 2

StatusCURRENT

Medical Necessity / Determinations

Coverage Rationale / Medically Necessary Determination

The following are unproven and not medically necessary for treating any condition due to insufficient evidence of efficacy:

Not Medically Necessary

Sensory Integration Therapy (SIT): Sensory integration therapy (SIT) is unproven and not medically necessary for treating any condition due to insufficient evidence of efficacy.
SIT seeks to improve processing and integration of sensory information using vestibular, proprioceptive, and tactile stimulation delivered by occupational therapists; evidence includes small RCTs with methodological limitations, conflicting larger trials (e.g., SenITA RCT) and population studies raising potential harm.
Auditory Integration Training (AIT): Auditory integration training (AIT) is unproven and not medically necessary for treating any condition due to insufficient evidence of efficacy.
AIT (e.g., Berard, TOMATIS) protocols lack standardized, consistent supportive evidence; professional organizations consider AIT investigational and guidance advises against its use.

Not Covered / Investigational

Policy position: the policy states that the following are unproven and not medically necessary for treating any condition due to insufficient evidence of efficacy: Sensory integration therapy (SIT) and Auditory integration training (AIT).

Coding

Applicable Procedure Codes (reference only)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 Actions & Administrative Notes

Documentation Required

State-specific applicability

This medical policy applies only to the state of Pennsylvania. Requests for services that do not meet criteria set in the Pennsylvania Administrative Code/Regulations will be evaluated on a case-by-case basis. Providers should refer to the Pennsylvania Code, Title 55, Chapter 1101 for applicable state-specific rules and exceptions.

Documentation Required

Reference federal/state/contractual benefit terms

When determining coverage, providers must reference and follow federal, state, or contractual benefit terms, as these requirements may differ from this standard medical policy and will govern in the event of a conflict. Verify applicable plan terms and legal requirements before relying on this policy for coverage decisions.

Documentation Required

Use of third-party decision tools

UnitedHealthcare may use third-party decision tools to assist in administering benefits and making coverage determinations. An example of such a tool is InterQual; providers should be aware these tools may be applied in benefit administration.

Background & Evidence Summary

Background: Sensory Integration Therapy (SIT) aims to improve perception and integration of sensory information (vestibular, proprioceptive, tactile) to help individuals with learning, sensorimotor, or developmental disorders; it is usually delivered by occupational therapists in individual sessions of approximately 60–90 minutes using activities and specialized equipment (e.g., swings, ramps, weighted vests) delivered over weeks to months. Auditory Integration Training (AIT) (for example, Berard or TOMATIS) involves modulated/listened-to sound protocols, typically delivered as a series of supervised listening sessions totaling about 10 hours over 10–12 days or other multi-session schedules. The equipment used for SIT and AIT is not considered medical by the FDA, and the literature for AIT is limited, heterogeneous, and raises safety and methodological concerns (distress or potential hearing risk and lack of standardized protocols).

Evidence Item	Summary
Key systematic reviews/RCTs	Multiple systematic reviews and RCTs report mixed results: some small RCTs suggest benefit for individualized goals (e.g., Schaaf 2018; Acuña 2025), but larger trials such as the SenITA RCT (Randell et al. 2022) found no superior effectiveness; AHRQ (Weitlauf 2017) noted low strength evidence for sensory-related and motor outcomes. Overall evidence limited by small samples, heterogeneity, short follow-up, and risk of bias.
AIT evidence summary	Published literature on auditory integration training is limited, heterogeneous, and often uncontrolled. Older RCTs are not consistently supportive; some recent small trials (e.g., TOMATIS and combination trials in non‑US populations) report positive findings but have design limitations and limited generalizability. Professional bodies (AAA 2010; ASHA 2004) consider AIT investigational, with safety concerns including potential distress or hearing risk.
NICE Guideline	NICE guideline CG170 (Autism spectrum disorder in under 19s; updated 2021) states that auditory integration training to manage speech and language problems in children and young people with autism should not be used.
Recent RCTs / Trials cited	Recent trials include SenITA RCT (Randell et al. 2022) showing no overall benefit; multiple 2025 RCTs (Wen & Wu 2025; Yamanishi 2025) and smaller RCTs (Omairi 2022, Cemali 2022, Kelly 2023) report variable results with limitations (small N, short duration, blinding issues).
Systematic reviews	Systematic and comparative reviews (Acuña 2025; Schaaf 2018; Case‑Smith 2015; AHRQ/Weitlauf 2017) conclude limited or low‑strength evidence: ASI may help attainment of individualized goals but not consistently improve broader behaviors; more rigorous, larger trials needed.

Definitions

Sensory Integration Therapy (SIT)Therapy aiming to improve processing and integration of sensory information using vestibular, proprioceptive, and tactile stimulation delivered by occupational therapists, often involving specialized equipment and sessions lasting 60-90 minutes.

Auditory Integration Training (AIT)Sound-based interventions (e.g., Berard, TOMATIS) that modulate audio stimuli over multiple sessions intended to improve abnormal sound sensitivity and related behaviors; typical Berard protocol is ~10 hours over 10–12 days using modulated music and headphones.

Revision History

2025-12-01revised

Updated Clinical Evidence and References; archived previous policy version CS108PA.M