Printer Friendly Version
Printer Friendly Version
A.8.03.13
Sensory integration therapy has been proposed as a treatment of developmental disorders in individuals 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.
Auditory integration therapy (also known as auditory integration training, auditory enhancement training, audio-psycho-phonology) involves having individuals listen to music 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 has been proposed for individuals with a range of developmental and behavioral disorders, including learning disabilities, autism spectrum disorder, pervasive developmental disorder, and 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 the FDA.
Sensory integration therapy may be considered a component of cognitive rehabilitation therapy. However, Cognitive Rehabilitation is addressed in a separate policy.
Sensory integration therapyand auditory integration therapy areconsidered investigational.
Federal 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.
The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
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.
5/2000: 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 A.8.03.13 added.
03/28/2017: Policy reviewed; no changes.
04/10/2018: Policy description updated. Policy statement unchanged.
04/05/2019: Policy description updated to remove information regarding treatment. Policy statement unchanged.
04/16/2020: Policy reviewed; no changes.
05/27/2021: Policy reviewed; no changes.
05/19/2022: Policy reviewed; no changes.
04/17/2023: Policy reviewed; no changes.
04/26/2024: Policy reviewed; no changes.
04/22/2025: Policy description updated. Policy statement unchanged.
Blue Cross Blue Shield Association policy # 8.03.13
This may not be a comprehensive list of procedure codes applicable to this policy.
Code Number | Description |
CPT-4 | |
97533 | Sensory integrative technique to enhance sensory processing and promote adaptive responses to environmental demand, direct (one on one) patient contact by the provider, each 15 minutes |
HCPCS | |
G9041, G9042, G9043, G9044 | Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, self care/home management training (e.g. activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment), community/work reintegration training (e.g. shopping, transportation, money management, avocational activities and/or work environment modification analysis, work task analysis), direct one-on-one contact by the provider, each 15 minutes |
ICD-10 Procedure | |
ICD-10 Diagnosis |
CPT copyright American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.