Work Hardening Programs

Number: 0198

Policy

Aetna does not cover back school and other return to work/reintegration or vocational programs including work hardening programs as they are considered vocational training, and not treatment of illness or injury.  Aetna medical benefit plans provide coverage only for treatment of illness or injury.  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.

Table: CPT Codes / HCPCS Codes / ICD-10 Codes
Code Code Description

Information in the [brackets] below has been added for clarification purposes.   Codes requiring a 7th character are represented by "+":

CPT codes not covered for indications listed in the CPB:

97537 Community/work reintegration training (eg, shopping, transportation, money management, avocational activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 15 minutes
97545 Work hardening/conditioning; initial 2 hours
+ 97546     each additional hour (List separately in addition to code for primary procedure)

HCPCS codes not covered for indications listed in the CPB:

S9117 Back school, per visit

ICD-10 codes not covered for indications listed in the CPB (not all-inclusive):

S00.00X+ - T88.9XX+ Injuries and poisonings
Z51.89 Encounter for other specified aftercare [vocational therapy and other specified rehabilitation procedure]
Z85.00 - Z85.9
Z86.19, Z86.59
Personal history of malignant neoplasm, mental disorders, or other diseases
Z87.81 - Z87.828, Z91.410 - Z91.414
Z92.3, Z98.870 - Z98.89
Personal history of surgery, irradiation, psychological trauma, injury, and poisoning

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.