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.
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||Work hardening/conditioning; initial 2 hours|
|+ 97546||each additional hour (List separately in addition to code for primary procedure)|
|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|