Medical Policy: 08.03.04
Original Effective Date: August 2000
Reviewed: April 2015
Revised: April 2015
Benefit determinations are based on the applicable contract language in effect at the time the
services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary
based on contract, and individual member benefits must be verified. Wellmark determines medical
necessity only if the benefit exists and no contract exclusions are applicable. This medical
policy may not apply to FEP. Benefits are determined by the Federal Employee Program.
This Medical Policy document describes the status of medical technology at the time the document
was developed. Since that time, new technology may have emerged or new medical literature may
have been published. This Medical Policy will be reviewed regularly and be updated as scientific
and medical literature becomes available.
Sensory Integration Therapy (SIT)
Sensory integration refers to the process by which the brain organizes and interprets external stimuli such as touch, movement, body awareness, sight, sound and gravity. It has been suggested that certain behavioral and emotional problems result from the malfunctioning of this process.
Sensory integration therapy (SIT) usually involves activities that provide vestibular, proprioceptive, and tactile stimuli, which are selected to match specific sensory processing deficits of the child. This type of therapy requires activities that consist of full body movements employing different kinds of equipment such as textured mitts, brushes, balls, carpets squares, scooter boards, ramps, swings and bounce pads. It is believed that SIT does not teach higher level skills, but enhances the sensory processing abilities of the patient to acquire them. Sensory Integration therapy is used as a treatment for children with learning disabilities and other behavioral disorders (e.g. autism, attention deficit disorder, fragile X syndrome and developmental delay).
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 therapy. The sessions are often provided as part of a comprehensive occupational therapy or cognitive rehabilitation therapy treatment plan and may last for more than one year.
Overall, the evidence remains insufficient to evaluate the effect of this treatment on health outcomes. Very little research exists that supports the effectiveness of sensory integration therapy. Due to individual nature of sensory integration therapy and the large variation in individual therapists and patients, large multi-center randomized controlled trials are needed to evaluate the efficacy of this intervention. Therefore, sensory integration therapy is considered investigational.
Auditory Integration (AI) Therapy
AI therapy (also known as AI training, auditory enhancement training, audio-psycho-phonology) is an intervention developed to correct or improve auditory hypersensitivity, distortions, and delays in the signals that interfere with an individual’s ability to process auditory information normally. Inconsistencies and distortions in the way sounds are perceived can make it difficult to interpret auditory stimuli. In addition, the ears must work together in a coordinated fashion. If the hearing in one ear is different than the other, the person may have auditory processing problems. This lack of coordination between the ears contributes to difficulties in following directions, comprehending what is said or read, and putting thoughts into words. Also, some people hear certain frequencies much better than other frequencies. When this occurs, the person perceives sounds in a distorted manner, may be easily distracted, and may have difficulty understanding auditory information. These auditory problems are thought to contribute to disorders such as learning disabilities, attention deficit, dyslexia, hyperactivity, central auditory processing disorder, sensory processing disorder, autism and pervasive developmental disorder.
Although several methods have been developed, the most widely described is the Berard method. The Berard method involves listening to music through headphones that is specifically modified by the Earductor TM, or the Audiokinetron, the two current devices designed for Berard AIT. These devices modulate the music, and may be used to filter out specific frequencies. The training is provided for 30 minutes, twice a day for a total of 10 hours. Audio tests prior to training and after the first 5 hours of training indicate whether any narrow band filters may be used. The minimum age is 3 years and there is no upper limit.
Other methods of AI include Tomatis method, which involves listening to electronically modified music and speech, and Somonas Sound Therapy, which involves listening to filtered music, voices and nature sounds.
For auditory integration (AI) therapy, the largest body of literature relates to its use in autism. Several systematic reviews of AI therapy in the treatment of autism found limited evidence to support its use. No comparative studies were identified that evaluated the use of AI therapy for other conditions. Therefore, the use of AI therapy is considered investigational.
Practice Guidelines and Position Statements
American Academy of Pediatrics (AAP)
A 2012 policy statement by the AAP on sensory integration therapies for children with developmental and behavioral disorders states that “Sensory based therapies are increasingly used by occupational therapists and sometimes by other types of therapists in treatment of children with developmental and behavioral disorders. However, it is unclear whether children who present with sensory-based problems have an actual “disorder” of the sensory pathways of the brain or weather these deficits are characteristics associated with other developmental and behavioral disorders. Because there is no universally accepted framework for diagnosis, sensory processing disorder generally should not be diagnosed. Other developmental and behavioral disorders must always be considered, and thorough evaluation should be completed. Difficulty tolerating or processing sensory information is characteristic that may be seen in many developmental behavioral disorders, including autism spectrum disorders, attention deficit/hyperactivity disorder, developmental coordination disorders and childhood anxiety disorders.”
“Occupational therapy with the use of sensory based therapies may be acceptable as one of the components of a comprehensive treatment plan. However, parents should be informed that the amount of research regarding the effectiveness of sensory integration is limited and inconclusive. Important roles for pediatricians and other clinicians may include discussing these limitations with parents.”
American Academy of Child and Adolescent Psychiatry (AACAP)
A 2013 practice parameter for the assessment and treatment of children and adolescents with autism spectrum disorder states that “Studies of sensory oriented interventions, such as auditory integration training (AIT), sensory integration therapy (SIT) and touch therapy/massage, have contained methodological flaws and have yet to show replicable improvements.”
American Occupational Therapy Association (AOTA)
In 2011, AOTA published evidence-based occupational therapy practice guidelines for children and adolescents with challenges in sensory processing and sensory integration (SI). AOTA gave a level C recommendation for SI therapy for individual functional goals for children, for parent-centered goals, and for participation in active play in children with sensory processing disorder and to address play skills and engagement in children with autism. A level C recommendation is based on weak evidence that the intervention can improve outcomes, and the balance of the benefits and harms may result in a recommendation that occupational therapy practitioners routinely provide the intervention to eligible clients or in no recommendation because the balance of the benefits and harm is too close to justify a general recommendation. Specific performance skills evaluated were motor and praxis skills, sensory-perceptual skills, emotional regulation, and communication and social skills. There was insufficient evidence to provide a recommendation on sensory integration for academic and psychoeducational performance (e.g. math, reading, written performance).
American Speech-Language Hearing Association (ASHA)
In 2003, the American Speech-Language-Hearing Association (ASHA) Working Group on Auditory Integration Training issued a report on Auditory Integration Training. The review concluded “Despite approximately one decade of practice in this country, this method has not met scientific standards for efficacy and safety that would justify its inclusion as mainstream treatment for these disorders.”
Sensory integration therapy (SIT) is considered investigational for all indications.
Overall the evidence is insufficient to evaluate the effect of this treatment on health outcomes. Due to the individual nature of sensory integration therapy and the large variation in individual therapists and patients, large multi-center randomized controlled trials are needed to evaluate the efficacy of this intervention. Therefore, the use of sensory integration therapy (SIT) is considered investigational.
Auditory integration therapy is considered investigational for all indications.
For auditory integration (AI) therapy, the largest body of literature relates to its use in autism. Several systematic reviews of AI therapy in the treatment of autism found limited evidence to support its use. No comparative studies were identified that evaluated the use of AI therapy for other conditions. Therefore, the use of auditory integration (AI) therapy is considered investigational.
Procedure Codes and Billing Guidelines:
- To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
- 97533 Sensory Integration Therapy
- AOTA (American Occupational Therapy Association) (1999). Statement: Sensory integration evaluation and intervention in school-based occupational therapy. (personal communication, Marian Scheinholtz, Practice Associate, AOTA, December 1, 1999).
- Case-Smith J, Bryan T. The effects of occupational therapy with sensory integration emphasis on preschool-age children with autism. American Journal of Occupational Therapy, 1999, 53(5): 489-497.
- Gresham FM, MacMillan DL. Early Intervention Project: can its claims be substantiated and its effects replicated. Journal of Autism Development Disorder,1998, 28(1):5-13.
- Vargas S, Camilli G. A meta-analysis of research on sensory integration treatment. American Journal of Occupational Therapy, 1999, 53(2): 189-98.
- Dawson G, Watling R. Interventions to facilitate auditory, visual, and motor integration in autism: a review of the evidence. J Autism Dev Disord. 2000 Oct;30(5):423-5.
- Miller, LJ, Coll, JR, Schoen, SA. A randomized controlled pilot study of the effectiveness of occupational therapy for children with sensory modulation disorder. Am J Occup Ther. 2007;61(2):228-238.
- Schaaf R, Blanche EI. Comparison of behavioral intervention and sensory-integration therapy in the treatment of challenging behavior. J Autism Dev Disord. 2011 Jun 11. [Epub ahead of print].
- Parham LD, Roley SS, May-Benson TA et al. Development of a fidelity measure for research on the effectiveness of the Ayres Sensory Integration intervention. Am J Occup Ther. 2011 Mar-Apr; 65(2):133-42.
- Pfeiffer BA, Koenig K, Kinnealey M et al. Effectiveness of sensory integration interventions in children with autism spectrum disorders: a pilot study. Am J Occup Ther. 2011 Jan-Feb; 65(1):76-85.
- Schaaf RC, Benevides TW, Kelly D, Mailloux-Maggio Z. Occupational therapy and sensory integration for children with autism: a feasibility, safety, acceptability and fidelity study. Autism. 2012 May;16(3):321-7.
- American Academy of Pediatrics: Zimmer M & Desch L. Sensory integration therapies for children with developmental and behavioral disorders. Pediatrics. 2012 June; 129(6):1186-9.
- American Academy of Pediatrics, Auditory Integration Training and Facilitated Communication for Autism, Pediatrics 1998;102;431
- American Occupational Therapy Association (AOTA) 2011 Occupational Therapy Practice Guidelines for Children and Adolescents with Challenges in Sensory Processing and Sensory Integration
- American Speech Language Hearing Association (ASHA) 2003 Technical Report Working Group in Auditory Integration Training
- National Institute of Health and Care Excellence (NICE) 2013 Guideline for Autism: The Management and Support of Children and Young People on the Autism Spectrum, Clinical guideline no. 170.
- The Berard AIT Website. Also available at www.berardaitwebsite.com
Date Reason Action
September 2011 Annual review Policy renewed
September 2012 Annual review Policy renewed
August 2013 Annual review Policy renewed
April 2015 Annual review Policy revised
Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
assist in administering plan benefits and constitute neither offers of
coverage nor medical advice. Wellmark medical policies contain only a
partial, general description of plan or program benefits and do not
constitute a contract. Wellmark does not provide health care services
and, therefore, cannot guarantee any results or outcomes.
Participating providers are independent contractors in private
practice and are neither employees nor agents of Wellmark or its
affiliates. Treating providers are solely responsible for medical
advice and treatment of members. Our medical policies may be updated
and therefore are subject to change without notice.
*Current Procedural Terminology © 2012 American Medical Association. All Rights Reserved.