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DESCRIPTIONSensory integration (SI) therapy has been proposed as a treatment of developmental disorders in patients with established dysfunction of sensory processing, particularly autism spectrum disorder. Sensory integration therapy may be offered by occupational and physical therapists who are certified in sensory integration therapy. Auditory integration therapy uses gradual exposure to certain types of sounds to improve communication in a variety of developmental disorders, particularly autism.
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 Torrance, Calif, and Western Psychological Services, a private organization that has a collaborative arrangement with University of Southern California (USC), Los Angeles, to offer sensory integration therapy 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 one year.
Auditory integration (AI) therapy (also known as AI training, auditory enhancement training, audio-psycho-phonology) is another method, which involves having individuals listen to music that has been modified to remove frequencies to which they are hypersensitive, with the goal of gradually increasing exposure to sensitive frequencies. Although several methods of auditory integration therapy have been developed, the most widely described is the Berard method, which involves two half-hour sessions per day separated by at least three hours, over ten consecutive days, during which patients listen to recordings. Auditory integration therapy training has been proposed for individuals with a range of developmental and behavioral disorders, including learning disabilities, autism spectrum disorders, pervasive developmental disorder, attention-deficit/hyperactivity disorder. Other methods include the Tomatis method, which involves listening to electronically-modified music and speech, and Samonas Sound Therapy, which involves listening to filtered music, voices, and nature sounds.
Sensory integration therapy is a procedure and, as such, is not subject to regulation by the U.S. Food and Drug Administration (FDA). No devices designed to provide auditory integration therapy have been cleared for marketing by FDA.
Sensory integration therapy may be considered a component of cognitive rehabilitation therapy. However, cognitive rehabilitation is addressed in a separate policy.
POLICYSensory integration (SI) therapy and auditory integration therapy are considered investigational.
POLICY EXCEPTIONSFederal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
Investigative is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized as a generally accepted standard of good medical practice for the treatment of the condition being treated and; therefore, is not considered medically necessary. For the definition of Investigative, “generally accepted standards of medical practice” means standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community, and physician specialty society recommendations, and the views of medical practitioners practicing in relevant clinical areas and any other relevant factors. In order for equipment, devices, drugs or supplies [i.e, technologies], to be considered not investigative, the technology must have final approval from the appropriate governmental bodies, and scientific evidence must permit conclusions concerning the effect of the technology on health outcomes, and the technology must improve the net health outcome, and the technology must be as beneficial as any established alternative and the improvement must be attainable outside the testing/investigational setting.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
POLICY HISTORY5/2000: Approved by Medical Policy Advisory Committee (MPAC)
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.
01/22/2014: Policy reviewed; no changes.
12/05/2014: Policy title changed from "Sensory Integration Therapy" to "Sensory Integration Therapy and Auditory Integration Therapy." Policy description updated to add auditory integration therapy information. Policy statement revised to include auditory integration therapy as investigational.
07/23/2015: Code Reference section updated for ICD-10.
04/22/2016: Policy description updated. Policy statement unchanged. Investigative definition updated in policy guidelines section.
05/27/2016: Policy number added.
SOURCE(S)Blue Cross Blue Shield Association policy #8.03.13
CODE REFERENCEThis may not be a comprehensive list of procedure codes applicable to this policy.