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Clinical Policy Bulletin:
Work Hardening Programs
Number: 0198


Policy

Aetna does not cover work hardening programs as they are considered vocational training, and not treatment of illness, injury, or other medical conditions.  Aetna medical benefit plans provide coverage only for treatment of injury or disease.  Please check benefit plan descriptions for details.

See also CPB 0169 - Outpatient Medical Self-Care Programs.



Background

Work hardening programs refer to physical conditioning programs for injured workers who are out of work, or who are working at less than full capacity.  Work hardening is a highly specialized rehabilitation program that transitions the patient from standard rehabilitation to return to work by simulating workplace activities and surroundings in a monitored environment.  A wide range of programs conducted by a number of different health disciplines have been reported in the professional and scientific literature.  In general, work hardening programs include a systematic program of gradually progressive, work-related activities performed with proper body mechanics, with the goal of physically and psychologically reconditioning the patient in order to facilitate return to full employment.

 
CPT Codes / HCPCS Codes / ICD-9 Codes
CPT codes not covered for indications listed in the CPB:
97545
+ 97546
ICD-9 codes not covered for indications listed in the CPB (not all-inclusive):
800.00 - 999.9 Injuries and poisonings
V10.00 - V13.9 Personal history of malignant neoplasm, mental disorders, or other diseases
V15.1 - V15.6 Personal history of surgery, irradiation, psychological trauma, injury, and poisoning
V57.22 Encounter for vocational therapy
V57.89 Care involving use of other specified rehabilitation procedure


The above policy is based on the following references:
  1. Lechner DE. Work hardening and work conditioning interventions: Do they affect disability? Phys Ther. 1994;74(5):471-493.
  2. Niemeyer LO, Jacobs K, Reynolds-Lynch K, et al. Work hardening: Past, present, and future--the work programs special interest section national work-hardening outcome study. Am J Occup Ther. 1994;48(4):327-339.
  3. Brewer CC, Storms BS. The final phase of rehabilitation: Work hardening. Orthop Nurs. 1993;12(6):9-15.
  4. King PM. Outcome analysis of work-hardening programs. Am J Occup Ther. 1993;47(7):595-603.
  5. American Occupational Therapy Association. Work hardening guidelines (position paper). Am J Occup Ther. 1986;40(12):841-843.
  6. Wyman DO. Evaluating patients for return to work. Am Fam Physician. 1999;59(4):844-848.
  7. Weir R, Nielson WR. Interventions for disability management. Clin J Pain. 2001;17(4 Suppl):S128-S132.
  8. Schonstein E, Kenny DT, Keating J, Koes BW. Work conditioning, work hardening and functional restoration for workers with back and neck pain. Cochrane Database Syst Rev. 2003;(1):CD001822.
  9. Lemstra M, Olszynski WP. The effectiveness of standard care, early intervention, and occupational management in Workers' Compensation claims: Part 2. Spine. 2004;29(14):1573-1579.
  10. Baker P, Goodman G, Ekelman B, Bonder B. The effectiveness of a comprehensive work hardening program as measured by lifting capacity, pain scales, and depression scores. Work. 2005;24(1):21-31.
  11. Cole K, Kruger M, Bates D, et al. Physical demand levels in individuals completing a sports performance-based work conditioning/hardening program after lumbar fusion. Spine J. 2009;9(1):39-46.


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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna 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 Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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