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The goal of sensory integration therapy is to improve the way the brain processes and adapts to sensory information, as opposed to teaching specific skills. Therapy usually involves activities that provide vestibular, proprioceptive, and tactile stimuli, which are selected to match specific sensory processing deficits of the child. For example, swings are commonly used to incorporate vestibular input, while trapeze bars and large foam pillows or mats may be used to stimulate somatosensory pathways of proprioception and deep touch. Tactile reception may be addressed through a variety of activities and surface textures involving light touch.

Treatment sessions are usually delivered in a one-on-one setting by occupational therapists with special training from university curricula, clinical practice, and mentorship in the theory, techniques, and assessment tools unique to sensory integration theory. Two organizations currently offer certification for sensory integration therapy; Sensory Integration International (SII), a non-profit branch of the Ayres Clinic in Torrence, Calif, and Western Psychological Services, a private organization that has a collaborative arrangement with University of Southern California (USC) to offer sensory integration training through USC’s Department of Occupational Science and Therapy. The sessions are often provided as part of a comprehensive occupational therapy or cognitive rehabilitation therapy and may last for more than 1 year.

Sensory integration therapy may be considered a component of cognitive rehabilitation therapy. However, cognitive rehabilitation is addressed in a separate policy.

Investigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.

The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.

2/11/2002: Investigational definition added

5/7/2002: Type of Service and Place of Service deleted

10/3/2002: Description section revised to be consistent with BCBSA policy, Hyperlink added, Code Reference section completed

10/23/2003: Code Reference section reviewed, no changes

3/17/2006: Coding updated. HCPCS revisions added to policy

1/10/2008: Policy reviewed, no changes

04/13/2010: Policy description updated. Policy statement unchanged. FEP verbiage added to the Policy Exceptions section.

12/30/2010: Policy reviewed; no changes.

12/01/2011: Policy reviewed. Policy statement unchanged. Deleted outdated references from Sources section. 

12/13/2012: Policy reviewed; no changes.

All codes billed for this procedure are considered investigational and not eligible for coverage. 

Non-Covered Codes

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