All PlansCoverageHigh impact
Sensory and Auditory Integration Therapy (CPB 0256, reviewed 2026-04-15)
Aetna·Occupational Therapy, Physical Therapy, Speech Therapy +3 more·Medical Policy
Effective date
Apr 15, 2026
We identified it
Aug 14, 2026
Summary
Aetna has classified Sensory and Auditory Integration Therapy (CPT 97533) as experimental, investigational, or unproven and will not cover it for any indication. Effective immediately, all claims for sensory integration therapy and auditory integration training submitted under this code for the listed ICD-10 diagnoses will be denied. This is a non-coverage determination for a previously reimbursable service.
Action Required
Immediately upon policy implementation (April 15, 2026): Billing team must update all billing software and claim submission rules to deny or reject all claims for CPT 97533 when billed with any ICD-10 diagnosis code in the following ranges: F43.20–F43.29, F80.9, F81.0–F81.9, F84.0–F84.9, F90.0–F90.9, F91.0–F91.9, F93.0–F93.9, Q99.2, R62.50, and Z03.89. Providers must be notified immediately that this service is no longer covered under Aetna plans. Update encounter forms, patient education materials, and internal documentation to reflect non-coverage status. Establish denial management process: flag all denied CPT 97533 claims for patient financial counseling and potential appeals. Billing team should verify claim denials and educate patients that CPT 97533 is experimental and not a covered benefit under Aetna policies. Failure to implement these changes will result in claim denials, payment recovery requests, and potential compliance issues.