97533 CPT® code: payer coverage and prior authorization57 of 58 payer prior-auth lists that name 97533 require prior authorization or set conditions: Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Blue Shield of California, CarePlus Health Plans, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, Oxford Health Plans, Passport by Molina Healthcare (Kentucky), Rocky Mountain Health Plans, UnitedHealthcare, UnitedHealthcare Community Plan.
97533 appears in 38 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross & Blue Shield of Rhode Island, Blue Cross Blue Shield of Massachusetts, Blue Shield of California, BlueCross BlueShield of South Carolina, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Attention Deficit/Hyperactivity Disorder (0426) EEG theta/beta power ratio, Gut microbiota profile, polygenic risk score, evaluation of kynurenine pathway | not covered | Jul 7, 2026 | payer document |
| Aetna | Autism Spectrum Disorders (0648) | listed, no stance (range 97010-97546) | Oct 2, 2025 | payer document |
| Aetna | Autism Spectrum Disorders (0648) | not covered | Oct 2, 2025 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 97010-97799) | Oct 6, 2026 | payer document |
| Aetna | Back Pain - Invasive Procedures (0016) | listed, no stance (range 97010-97763) | Oct 6, 2026 | payer document |
| Aetna | Behavioral Vision Therapy and Vision Restoration Therapy (0321) | listed, no stance | May 21, 2026 | payer document |
| Aetna | Burn Garments (0062) | listed, no stance (range 97110-97546) | Jan 15, 2026 | payer document |
| Aetna | Chiropractic Services (0107) | listed, no stance (range 97010-97799) | Apr 7, 2026 | payer document |
| Aetna | Chronic Pain Rehabilitation Programs (0237) | listed, no stance (range 97010-97546) | Apr 23, 2026 | payer document |
| Aetna | Early Intervention Programs (0444) | listed, no stance (range 97110-97546) | Jul 1, 2026 | payer document |
| Aetna | Electrodiagnostic Testing (0502) | listed, no stance (range 97010-97799) | Jul 29, 2026 | payer document |
| Aetna | Functional Electrical Stimulation and Neuromuscular Electrical Stimulation (0677) | listed, no stance (range 97010-97763) | Sep 10, 2026 | payer document |
| Aetna | Hip Arthroplasty (0287) | listed, no stance (range 97010-97546) | Sep 23, 2026 | payer document |
| Aetna | Home Health Aides (0218) | listed, no stance (range 97010-97799) | Sep 10, 2026 | payer document |
| Aetna | Intervertebral Disc Prostheses (0591) | listed, no stance (range 97110-97546) | Sep 18, 2026 | payer document |
| Aetna | Knee Arthroplasty (0660) | listed, no stance (range 97010-97799) | Oct 8, 2026 | payer document |
| Aetna | Sensory and Auditory Integration Therapy (0256) | not covered | Apr 15, 2026 | payer document |
| Aetna | Spinal Surgery: Laminectomy and Fusion (0743) | listed, no stance (range 97110-97546) | Jul 30, 2026 | payer document |
| Aetna | Standing Frames, Tables, and Transfer Boards (0481) | listed, no stance (range 97001-97763) | Jul 2, 2026 | payer document |
| Aetna | Total Ankle Arthroplasty (0645) | listed, no stance (range 97001-97799) | Sep 14, 2026 | payer document |
| Aetna | Vasectomy Procedures and Chronic Scrotal Content Pain (0027) | listed, no stance (range 97010-97799) | Jan 27, 2026 | payer document |
| Blue Cross & Blue Shield of Mississippi | Sensory Integration Therapy And Auditory Integration Therapy | unproven / investigational | payer document | |
| Blue Cross & Blue Shield of Rhode Island | Sensory Integration Therapy and Auditory Integration Therapy | not covered | May 20, 2026 | payer document |
| Blue Cross Blue Shield of Massachusetts | Sensory Integration Therapy (659) | unproven / investigational | payer document | |
| Blue Shield of California | BSC8.03 | Physical Therapy | listed, no stance | payer document | |
| BlueCross BlueShield of South Carolina | Sensory Integration Therapy and Auditory Integration Therapy (CAM 80313) | listed, no stance | Apr 1, 2026 | payer document |
| Centene | Attention Deficit Hyperactivity Disorder Assessment and Treatment (CP.MP.124) | not covered | Feb 1, 2022 | payer document |
| Centene | Attention Deficit Hyperactivity Disorder Assessment and Treatment (CP.BH.124) | not covered | Mar 1, 2024 | payer document |
| Centene | Skilled Nursing Facility Leveling (CP.MP.206) | covered if criteria are met | Aug 1, 2022 | payer document |
| Health Care Service Corporation (BCBS IL, TX, OK, NM, MT) | Sensory Integration Therapy and Auditory Integration Therapy (THE803.020) | listed, no stance | Sep 15, 2026 | payer document |
| UnitedHealthcare | Sensory Integration Therapy and Auditory Integration Training (2026T0314CC) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Sensory Integration Therapy and Auditory Integration Training (CS108.O) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Sensory Integration Therapy and Auditory Integration Training (for Nebraska Only) (CS108NE.O) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Sensory Integration Therapy and Auditory Integration Training (for New Jersey Only) (CS108NJ.M) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Sensory Integration Therapy and Auditory Integration Training (for New Mexico Only) (CS108NM.C) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Sensory Integration Therapy and Auditory Integration Training (for North Carolina Only) (CSNCT0314.04) | listed, no stance | Mar 1, 2026 | payer document |
| UnitedHealthcare | Sensory Integration Therapy and Auditory Integration Training (for Ohio Only) (CS108OH.E) | listed, no stance | Feb 1, 2026 | payer document |
| UnitedHealthcare | Sensory Integration Therapy and Auditory Integration Training (for Pennsylvania Only) (CS108PA.N) | listed, no stance | Dec 1, 2025 | payer document |
| UnitedHealthcare | Sensory Integration Therapy and Auditory Integration Training (for Tennessee Only) (CS108TN.N) | listed, no stance | Jan 1, 2026 | payer document |
| UnitedHealthcare | Skilled Nursing Facility, Rehabilitation, Long-Term Acute Care Hospital, and Private Duty Nursing (MMP079.19) | listed, no stance | Sep 1, 2026 | payer document |
Prior authorization required or conditional in CO, IN, MS, WV.
From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.