Billing for Occupational Therapy Services That Use Ayres Sensory Integration®

Children with sensory integration and processing challenges often require occupational therapy to support participation in daily activities. Ayres Sensory Integration® (ASI) is a theory-driven, evidence-based intervention delivered by qualified practitioners using a manualized approach. Despite strong evidence supporting ASI, reimbursement for occupational therapy services using Current Procedural Terminology® (CPT) Code 97533 remains inconsistent. In this column, we clarify the distinctions between ASI and sensory-based interventions, outline billing and documentation requirements for CPT Code 97533, and examine common barriers to reimbursement that have led to underutilization of the code and inaccurate documentation of ASI services. We propose that CPT Code 97533 be reserved for ASI delivered with fidelity to ASI principles and by clinicians with advanced training; recommend a language change to the code's descriptor to ensure clarity, accuracy, and ethical documentation; and outline a coordinated, multilevel strategy, including targeted education for practitioners and payers and engagement with advocacy organizations. Accurate coding and policy alignment are essential to support access to evidence-based care and to advance health services research in pediatric occupational therapy.