Sensory Integration Therapy and Auditory Integration Training (for North Carolina Only)
State-specific UnitedHealthcare medical policy for North Carolina governing Sensory Integration Therapy (SIT) and Auditory Integration Training (AIT), with coverage directed to follow the North Carolina Medicaid Clinical Coverage Policy for medical necessity criteria.
Replaced coverage guidelines with instruction to refer to the North Carolina Medicaid (Division of Health Benefits) Clinical Coverage Policy, Specialized Therapies: 10A, Outpatient Specialized Therapies for medical necessity clinical coverage criteria.
Removed Clinical Evidence section from the policy.
Updated References section to reflect the most current information and archived previous policy version CSNCT0314.03.
Coverage and Medical Necessity Criteria
Medical necessity (deferred to NC Medicaid 10A)
Coverage and medical necessity determinations
Providers must use NC Medicaid 10A for criteria; this policy provides direction rather than specific criteria.
The policy clarifies that the equipment commonly used for Sensory Integration Therapy (SIT) and Auditory Integration Training (AIT) — for example, swings, weighted vests, or other sensory devices — is not considered medical in nature and is therefore not regulated by the U.S. Food and Drug Administration (FDA). This regulatory status is provided for informational purposes and does not itself determine benefit coverage.
Inclusion of a procedure or diagnosis code in this policy is for reference only and does not imply that the service described by the code is a covered or non-covered health service. Benefit coverage and any right to reimbursement are governed by applicable federal, state, or contractual requirements and laws; listing a code does not guarantee claim payment.
Coding and Billing References
| 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 Action Items
Follow NC Medicaid 10A for medical necessity and authorization
Medical necessity clinical coverage criteria are determined by the North Carolina Medicaid (Division of Health Benefits) Clinical Coverage Policy, Specialized Therapies: 10A, Outpatient Specialized Therapies; providers must follow NC Medicaid 10A to determine authorization and medical necessity for SIT/AIT services.
No step therapy specified
This policy does not specify any step therapy requirements for Sensory Integration Therapy or Auditory Integration Training; follow applicable federal, state, or contractual benefit rules if step therapy rules are required by the governing plan.
Check governing benefit documents when deciding coverage
When deciding coverage, reference the federal, state, or contractual requirements for benefit plan coverage because those terms may differ from the standard benefit plan and, in the event of conflict, federal/state/contractual requirements govern.
- Check the applicable federal, state, or contractual benefit documents before using this policy.
- If there is a conflict, the federal, state, or contractual requirements control.
Coding listing is informational — listing a code does not imply coverage
Listing of a code in this policy is for reference only and does not imply that the service described by the code is a covered or non‑covered health service; benefit coverage is determined by federal, state, or contractual requirements and applicable laws.
- Inclusion of a code does not guarantee reimbursement or claim payment.
Background
Sensory Integration Therapy (SIT) aims to improve an individual’s ability to perceive and integrate sensory inputs (vestibular, proprioceptive, tactile) to support adaptive motor responses and sensory processing. SIT is typically delivered by occupational therapists using targeted sensory activities and equipment to elicit adaptive responses and may be provided in sessions often lasting about 60–90 minutes over a course of weeks to months as clinically indicated.
Key Definitions
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