Name of Policy:
Sensory Integration Therapy and Auditory Integration Therapy
Policy #: 333
Category: Therapy
Latest Review Date: November 2014
Policy Grade: B
Background/Definitions:
As a general rule, benefits are payable under Blue Cross and Blue Shield of Alabama health
plans only in cases of medical necessity and only if services or supplies are not investigational,
provided the customer group contracts have such coverage.
The following Association Technology Evaluation Criteria must be met for a service/supply to be
considered for coverage:
1. The technology must have final approval from the appropriate government regulatory
bodies;
2. The scientific evidence must permit conclusions concerning the effect of the technology
on health outcomes;
3. The technology must improve the net health outcome;
4. The technology must be as beneficial as any established alternatives;
5. The improvement must be attainable outside the investigational setting.
Medical Necessity means that health care services (e.g., procedures, treatments, supplies,
devices, equipment, facilities or drugs) that a physician, exercising prudent clinical judgment,
would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an
illness, injury or disease or its symptoms, and that are:
1. In accordance with generally accepted standards of medical practice; and
2. Clinically appropriate in terms of type, frequency, extent, site and duration and
considered effective for the patient’s illness, injury or disease; and
3. Not primarily for the convenience of the patient, physician or other health care provider;
and
4. Not more costly than an alternative service or sequence of services at least as likely to
produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of
that patient’s illness, injury or disease.
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Description of Procedure or Service:
Sensory integration (SI) therapy has been proposed as a treatment of developmental disorders in
patients with established dysfunction of sensory processing, e.g., children with autism, attention
deficit hyperactivity disorder (ADHD), brain injuries, fetal alcohol syndrome, and
neurotransmitter disease. 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 (SI) 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 SI theory. Two organizations currently offer
certification for SI therapy; Sensory Integration International (SII), a nonprofit 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 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 therapy (also known as auditory integration training, auditory enhancement
training, and audio-psycho-phonology) is another method that relies on gradual exposure to
sound to which individuals are sensitive, based on having individuals listen to music that has
been modified to remove frequencies to which the individual is hypersensitive. Although several
methods 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 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 and
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.
Policy:
Sensory Integration Therapy (SIT) and auditory integration therapy do not meet Blue
Cross and Blue Shield of Alabama’s medical criteria for coverage and are considered
investigational.
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For constraint induced therapy, please refer to MP #188- Constraint Induced Movement or
Language Therapy.
For cognitive/neurobehavioral/neurorestorative rehabilitation, please refer to MP #600Cognitive/Neurobehavioral/Neurorestorative Rehabilitation.
Blue Cross and Blue Shield of Alabama does not approve or deny procedures, services, testing,
or equipment for our members. Our decisions concern coverage only. The decision of whether
or not to have a certain test, treatment or procedure is one made between the physician and
his/her patient. Blue Cross and Blue Shield of Alabama administers benefits based on the
members' contract and corporate medical policies. Physicians should always exercise their best
medical judgment in providing the care they feel is most appropriate for their patients. Needed
care should not be delayed or refused because of a coverage determination.
Key Points:
Sensory Integration Therapy
This policy was created in April 2000, based on a 1999 TEC Assessment which evaluated
sensory integration therapy, and updated periodically with literature reviews, most recently
through September 23, 2014. The literature related to the use of sensory integration therapy
consists primarily of small case series, along with a smaller number of comparative studies and
systematic reviews. Given the individualized nature of SI therapy and the potential for
confounding due to effects of treatment other than the SI therapy itself, large comparative studies
are needed to demonstrate effectiveness.
In 2014, Schaaf et al published an overview of current measurement issues in the area of sensory
integration. This review highlights the need for the following: additional measures to ensure a
comprehensive assessment of the sensory and motor factors that may be influencing function and
participation; assessment measures that address a wider age range; neurophysiological studies;
expansion of the measurement of fidelity to the core principles of sensory integration therapy;
studies to evaluate the dosage of therapy to understand the best candidates for intervention and
the appropriate intensity/frequency of intervention; and identification of outcomes that are
meaningful to clients and sensitive to the changes observed after intervention.
The Sensory Processing Disorders Scientific Workgroup has discussed the methodologic
challenges of conducting intervention effectiveness studies of dynamic interactional processes,
the lack of scientific evidence to support current practice, and methods for improving the quality
of research in this area.
Systematic Reviews
Several systematic reviews have addressed the use of SI therapy in various clinical conditions.
The 1999 TEC Assessment compared the outcomes of sensory SI therapy with that of standard
occupational/physical therapy among children with autism, mental retardation, or learning
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disabilities. One study was identified that evaluated the use of SI therapy in patients with autism,
which was noted to be limited by its lack of a control group. Three studies were identified that
evaluated the use of SI therapy in patients with mental retardation, which were noted to be
inconsistent in their results regarding the superiority of SI therapy. Eleven studies were identified
that evaluated SI therapy in patients with learning disabilities or motor delay, including, in total,
more than 600 learning-disabled children. Studies that used random assignment and blinded
assessors suggested that SI therapy was not superior to conventional therapy and, in many cases,
was not even demonstrably superior to any treatment at all.
Case-Smith and Arbesman reviewed the evidence for SI therapy as part of a systematic review of
interventions for autism used in occupational therapy in 2008. The authors identified one level-I
study, which was a systematic review from 2002 that had found only lower quality evidence
(levels III and IV, with small sample size and lack of control groups), suggesting that SI
intervention was associated with positive changes in social interaction, purposeful play, and
decreased sensitivity. It was concluded that “although each of these studies had positive
findings, when combined, the evidence remains weak and requires further study.”
May-Benson and Koomar published a systematic review of SI therapy in 2010. The review
identified 27 research studies (13 level-I randomized trials) that met the inclusion criteria. Most
of the studies had been performed in children with learning or reading disabilities; there were
two case reports/small series on the effect of SI therapy in children with autism. The review
concluded that although the SI approach may result in positive outcomes, findings may be
limited because of small sample sizes, variable intervention dosage, lack of fidelity to
intervention, and selection of outcomes that may not be meaningful or may not change with the
treatment provided.
In 2014, Case-Smith et al published an updated systematic review of sensory processing
interventions, including sensory integration therapy (defined as clinic-based interventions that
use sensory-rich, child-directed activities to improve a child’s adaptive responses to sensory
experiences) and sensory-based interventions (defined as adult-directed sensory modalities that
are applied to the child to improve behaviors associated with modulation disorders), for children
with autism spectrum disorders with concurrent sensory processing problems. This review was
designed to focus on interventions that activate the somatosensory and vestibular systems for
patients with autism with co-occurring sensory processing problems. Nineteen studies published
since 2000 were included, five of which evaluated sensory integration therapy in patients with
autism spectrum disorders and sensory processing disorders. Two studies reviewed were RCTs,
which were small (N=20 and N=17 in the sensory integration groups); the authors noted that the
studies showed low or low-to-moderate effects and concluded that “It is premature to draw
conclusions as to whether SIT [sensory integration therapy] for children with ASD [autism
spectrum disorder], which is designed to support a child’s intrinsic motivation and sense of
internal control, is ultimately effective.”
Controlled Trials
In 2014, Schaaf et al reported results from a randomized trial of a manualized intervention for
sensory difficulties in children with autism, which was one of the RCTs reviewed by Case-Smith
et al above. The study enrolled 32 children from a convenience sample of eligible families with
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children aged four to eight who had a diagnosis of autism and demonstrated difficulty processing
and integrating sensory information as measured by the Sensory Profile or the Sensory
Integration and Praxis Test. Subjects were randomized to usual care or to an intervention
described as following the principles of sensory integration outlined by Ayres. The intervention
was delivered by three licensed occupational therapists with experience working with children
with autism spectrum disorders. The primary outcome was Goal Attainment Setting, a systematic
process for identifying goals that are relevant to individuals and their families that has been used
for evaluation of patients with autism. Sample goals include, “Improve auditory process as a
basis for sleeping through the night without getting out of bed for seven to eight hours per night,”
and “Decrease oral sensitivity and will try five new foods.” Each goal is associated with a scale
for level of attainment. For the primary outcome, the experimental group had a significantly
higher goal achievement score than the control group (mean 56.53 [N=17] vs 42.72 [N=14],
P=0.003). Change in functional skills did not differ significantly between groups, but
experimental group subjects had significantly greater improvements in self-care caregiver
assistance (P=0.008) and social function caregiver assistance (P=0.039). The groups did not
differ in terms of autistic or adaptive behaviors. One of the strengths of this study is its use of a
protocolized intervention and its attempt to use an outcome measure relevant to patients and
families. However, further replication in a larger sample of patients and further validation of the
Goal Attainment Setting score process.
A pilot study, reported in 2011, randomized 37 children with a sensory processing disorder (21
with autism and 16 with pervasive developmental disorder not otherwise specified) to SI
interventions or to fine motor interventions (18 treatments over six weeks). Fidelity to SI
interventions was verified with a fidelity measure developed for research by Parham et al.
Blinded evaluation at the conclusion of the intervention found no significant difference between
the two groups on the Quick Neurological Screening Test (QNST) or sensory processing scores
except for Autistic Mannerisms (e.g., stereotyped or self-stimulatory behavior) subscale. The SI
group demonstrated greater improvement than the fine motor group on individualized Goal
Attainment Scaling. Post hoc analysis found that more children in the SI group were able to
complete parts of the standardized QNST after the intervention. This finding is limited by the
post hoc analysis and the difference in the two groups at baseline.
In 2007, members of the Sensory Processing Disorders Scientific Workgroup also reported
results from a single institution randomized pilot study for a proposed multicenter trial. Thirty
families (of approximately 140 who met the inclusion/exclusion criteria) agreed to participate
over a three year period. The children had a clinical diagnosis of sensory modulation disorder
following a comprehensive evaluation with standardized and clinical testing (including responses
to sensory stimuli, attempts by the child to self-regulate, behavioral disorganization, and somatic
responses to the testing situations). The 24 children who began treatment were randomly
assigned to one of three groups consisting of occupational therapy with SI (two times per week
for ten weeks, n=7), equivalent activity control sessions (n=10), or a waiting-list control group
(n=7). Functional improvements were assessed by five validated/standardized parental rating
scales. Significant improvements relative to both control groups were obtained for Goal
Attainment Scaling (37 vs. 14 vs. 7, consecutively). A number of the other outcome measures
(Leitner International Performance Scale, Short Sensory Profile, and Internalizing on the Child
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Behavior Checklist) showed trends for improvement in this small study. Additional study with a
larger number of subjects is needed.
In a 2003 study of 45 children with Down’s syndrome divided into three treatment groups
(sensory integrative therapy alone, vestibular stimulation combined with sensory integrative
therapy, and neurodevelopmental therapy), Uyanik and colleagues reported greater
improvements in outcomes in the vestibular stimulation with SI therapy group and in the
neurodevelopmental therapy group when compared to the SI therapy alone group. Outcomes
assessed were the Ayres Southern California Sensory Integration Test, Pivot Prone Test,
Gravitational Insecurity Test, and Pegboard Test along with physical assessment. The authors
concluded all methods of treatment should be considered when planning rehabilitation therapies
for children with Down’s syndrome, even though sensory integrative therapy alone was not
shown to be superior to the other therapy groups.
Section Summary
The most direct evidence related to outcomes from sensory integration therapy comes from small
randomized trials. Although some of the studies demonstrated some improvements on subsets of
the outcomes measured, the studies are limited by small sizes, heterogeneous patient populations,
and variable outcome measures. As a result, the evidence is insufficient to draw conclusions
about the effects of and the most appropriate patient populations for sensory integration therapy.
Auditory Integration Therapy
Although auditory integration therapy has been proposed as a therapy for a number of
neurobehavioral disorders, the largest body of evidence on auditory integration therapy relates to
its use in autism spectrum disorder.
Several systematic reviews have evaluated the evidence related to auditory integration therapy
for autism spectrum disorders. A 2011 Cochrane review evaluated auditory integration training
along with other sound therapies for autism spectrum disorders. Included were six randomized
controlled trials of auditory integration therapy and one of Tomatis therapy, involving a total of
182 subjects aged 3 to 39 years. For most of the studies, the control condition consisted of
listening to unmodified music for the same time as the active treatment group. Allocation
concealment was inadequate for all studies, and five of the trials had fewer than 20 participants.
Meta-analysis could not be conducted. Three studies did not demonstrate any benefit of auditory
integration therapy over control conditions, and three studies had outcomes of questionable
validity or outcomes that did not achieve statistical significance. The review found no evidence
that auditory integration therapy is an effective treatment for autism spectrum disorders;
however, evidence was not sufficient to prove that it is not effective.
A 2010 systematic review of therapies for autism evaluated the evidence for auditory integration
training in the treatment of autism. The author identified a 2002 systematic review (an early
version of the 2011 Cochrane review by Sinha et al referenced above), which identified no RCTs
meeting the author’s inclusion criteria, and no subsequent RCTs or cohort studies comparing
auditory integration therapy to usual care.
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In 2009, Rossignol conducted a systematic review of novel and emerging treatments for autism
spectrum disorders, including auditory integration therapy. The authors identified one threemonth double-blind controlled study of auditory integration therapy in 17 individuals with
autism, which demonstrated significant improvements in irritability, stereotypy, hyperactivity,
and excessive speech in patients in the therapy group. The study also reviewed an earlier version
of the 2011 Cochrane review by Sinha et al referenced above. Overall, the authors concluded that
there was Grade C evidence related to the use of auditory integration therapy in autism (at least
one level IIb [individual prospective, nonrandomized cohort study or low-quality RCT] or IIIb
[systematic review of retrospective case-control studies with homogeneity] studies OR two level
IV studies [case series or reports]).
Section Summary
The largest body of evidence related to the use of auditory integration therapy is in the treatment
of autism. A 2011 Cochrane review and several earlier systematic reviews generally found that
studies of auditory integration therapy failed to demonstrate meaningful clinical improvements.
No subsequent comparative studies of auditory integration therapy were identified.
Summary
Due to the individual nature of sensory integration (SI) therapy and the large variation in
individual therapists and patients, large multicenter randomized controlled trials are needed to
evaluate the efficacy of this intervention. The most direct evidence related to outcomes from
sensory integration therapy comes from small randomized trials. Although some of the studies
demonstrated some improvements on subsets of the outcomes measured, the studies are limited
by small sizes, heterogeneous patient populations, and variable outcome measures. As a result,
the evidence is insufficient to draw conclusions about the effects of and the most appropriate
patient populations for sensory integration therapy, and the use of sensory integration therapy is
considered investigational.
For auditory integration therapy, the largest body of literature relates to its use in autism. Several
systematic reviews of auditory integration therapy in the treatment of autism found limited
evidence to support its use. No comparative studies were identified which evaluate the use of
auditory integration therapy for other conditions. Therefore, the use auditory integration therapy
is considered investigational.
Practice Guidelines and Position Statements
Sensory Integration Therapy
The American Academy of Pediatrics (AAP) stated in 2007 guidance that “the efficacy of SI
[sensory integration] therapy has not been demonstrated objectively.
A 2012 policy statement by the AAP on SI therapies for children with developmental and
behavioral disorders states that “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 therapy is limited and inconclusive.” The AAP indicates that these limitations should
be discussed with parents, along with instruction on how to evaluate the effectiveness of a trial
period of SI therapy.
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In 2009, the American Occupational Therapy Association (AOTA) stated that the AOTA
recognizes sensory integration (SI) as one of several theories and methods used by occupational
therapists and occupational therapy assistants working with children in public and private
schools to improve a child’s ability to access the general education curriculum and to participate
in school-related activities. In 2011, the AOTA published evidence-based occupational therapy
practice guidelines for children and adolescents with challenges in sensory processing and
sensory integration. AOTA gave a level C recommendation for sensory integration 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 either in a
recommendation that occupational therapy practitioners routinely provide the intervention or in
no recommendation because the balance of the benefits and harms is too close to justify a general
recommendation. Specific performance skills evaluated were motor and praxis skills, sensoryperceptual 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).
Auditory Integration Therapy
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 a mainstream
treatment for these disorders.”
In 1998, the AAP Committee on Children with Disabilities issued a statement on auditory
integration training and facilitated communication for autism, which concluded, “Currently
available information does not support the claims of proponents that these treatments are
efficacious. Their use does not appear warranted at this time, except within research protocols.”
U.S. Preventive Services Task Force Recommendations
Sensory integration therapy and auditory integration therapy are not preventive services.
Key Words:
Sensory integration therapy (SIT), auditory integration therapy (AIT), facilitated communication
(FC) therapy, Integrated Listening System Therapy, iLs
Approved by Governing Bodies:
Sensory integration therapy is a procedure and, as such, is not subject to regulation by the US
Food and Drug Administration (FDA). There are no devices designed to provide auditory
integration therapy that have clearance for marketing from FDA.
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Benefit Application:
Coverage is subject to member’s specific benefits. Group specific policy will supersede this
policy when applicable.
ITS: Home Policy provisions apply
FEP contracts: FEP does not consider investigational if FDA approved and will be reviewed for
medical necessity.
Coding:
CPT Codes:
97533
Sensory integrative technique to enhance sensory
processing and promote adaptive responses to
environmental demand, direct (one-on-one) patients
contact by the provider, each 15 minutes
The code above may also be used for auditory integration therapy.
References:
1. American Speech-Language-Hearing Association. Auditory integration training [Technical
Report]. 2004; www.asha.org/policy/TR2004-00260.htm#sec1.1.5.
2. American Academy of Pediatrics Committee on Children with Disabilities. Auditory
Integration Training and Facilitated Communication for Autism. Pediatrics. August 1, 1998
1998; 102(2):431-433.
3. Baranek GT. Efficacy of sensory and motor interventions for children with autism. J Autism
Dev Disord 2002; 32(5):397-422.
4. Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Sensory
integration therapy. TEC Assessment. 1999;Volume 14, Tab 22.
5. Case-Smith J, Arbesman M. Evidence-based review of interventions for autism used in or of
relevance to occupational therapy. Am J Occup Ther 2008; 62(4):416-29.
6. Case-Smith J, Weaver LL, Fristad MA. A systematic review of sensory processing
interventions for children with autism spectrum disorders. Autism. Jan 29 2014.
7. Kratz SV. Sensory integration intervention: historical concepts, treatment strategies and
clinical experiences in three patients with succinic semialdehyde dehydrogenase (SSADH)
deficiency. J Inherit Metab Dis 2009; 32(3):353-60.
8. Mailloux Z, May-Benson TA, Summers CA et al. Goal attainment scaling as a measure of
meaningful outcomes for children with sensory integration disorders. Am J Occup Ther
2007; 61(2):254-9.
9. May-Benson TA, Koomar JA. Systematic review of the research evidence examining the
effectiveness of interventions using a sensory integrative approach for children. Am J Occup
Ther 2010; 64(3):403-14.
10. 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):228-38.
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Proprietary Information of Blue Cross and Blue Shield of Alabama
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11. Myers SM, Johnson CP. Management of children with autism spectrum disorders. Pediatrics
2007; 120(5):1162-82.
12. Parham LD, Cohn ES, Spitzer S et al. Fidelity in sensory integration intervention research.
Am J Occup Ther 2007; 61(2):216-27.
13. Parr J. Autism. Clin Evid (Online). 2010;2010.
14. 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; 65(1):76-85.
15. Roley SS, Bissell J, Clark GF. Providing occupational therapy using sensory integration
theory and methods in school-based practice. Am J Occup Ther 2009; 63(6):823-42.
16. Rossignol DA. Novel and emerging treatments for autism spectrum disorders: a systematic
review. Ann Clin Psychiatry. Oct-Dec 2009;21(4):213-236.
17. Schaaf RC, Benevides T, Mailloux Z, et al. An intervention for sensory difficulties in
children with autism: a randomized trial. J Autism Dev Disord. Jul 2014;44(7):1493-1506.
18. Schaaf RC, Burke JP, Cohn E, et al. State of measurement in occupational therapy using
sensory integration. Am J Occup Ther. Sep-Oct 2014;68(5):e149-153.
19. Sinha Y, Silove N, Hayen A et al. Auditory integration training and other sound therapies
for autism spectrum disorders (ASD). Cochrane Database Syst Rev 2011; (12):CD003681.
20. Uyanik M, Bumin G, Kayihan H. Comparison of different therapy approaches in children
with Down syndrome. Pediatr Int 2003; 45(1):68-73.
21. Watling R, Koenig KP, Davies PL et al. Occupational therapy practice guidelines for
children and adolescents with challenges in sensory processing and sensory integration.
Bethesda, MD: American Occupational Therapy Association Press; 2011. Guideline
summary available online at: www.guidelines.gov/content.aspx?id=34041. Last accessed
December 2013.
22. Zimmer M, Desch L. Sensory integration therapies for children with developmental and
behavioral disorders. Pediatrics 2012; 129(6):1186-9.
Policy History:
Medical Policy Group, October 2008 (3)
Medical Policy Administration Committee, November 2008
Available for comment November 20, 2008-January 5, 2009
Medical Policy Group, October 2010 (1): Key points update, no policy statement change
Medical Policy Group, October 2011 (1): Update to Key Points and References related to SIT;
no change to policy statement.
Medical Policy Panel, October 2013.
Medical Policy Group, December 2013 (2): Deleted “Auditory Integration Therapy and
Facilitated Communication” from title, description, and policy statement. Key Points and
References updated to reflect findings from literature search through September 2013
Medical Policy Panel, November 2014
Medical Policy Group, November 2014 (4): Added “and Auditory Integration Therapy” back to
title and policy statement. Updates to Description, Key Points, and References
Medical Policy Group, October 2015 (4): Added “refer to” statements under policy section for
MP# 188 and 600.
Medical Policy Group, November 2015 (4): Added integrated listening therapy to Key Words
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This medical policy is not an authorization, certification, explanation of benefits, or a contract. Eligibility and benefits are determined on a caseby-case basis according to the terms of the member’s plan in effect as of the date services are rendered. All medical policies are based on (i)
research of current medical literature and (ii) review of common medical practices in the treatment and diagnosis of disease as of the date
hereof. Physicians and other providers are solely responsible for all aspects of medical care and treatment, including the type, quality, and levels
of care and treatment.
This policy is intended to be used for adjudication of claims (including pre-admission certification, pre-determinations, and pre-procedure
review) in Blue Cross and Blue Shield’s administration of plan contracts.
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