Work Hardening Programs

Number: 0198

Table Of Contents

Applicable CPT / HCPCS / ICD-10 Codes


Scope of Policy

This Clinical Policy Bulletin addresses work hardening programs.

  1. Policy Limitations and Exclusions 

    Aetna does not cover back school for occupational purposes 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.

    Note: Aetna medical benefit plans provide coverage only for treatment of illness or injury. Please check benefit plan descriptions for details. 

  2. Related Policies


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


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.

Cognitive Work Hardening for Return-to-Work Following Depression

Wisenthal (2021) noted that the growing number of mental health disability claims and related work absences are associated with a magnitude of human, economic and social costs with profound impact on the workplace.  In particular, absences due to depression are prevalent and escalating.  There is a need for treatments that address the unique challenges of individuals returning-to-work following an episode of depression.  Occupational functioning often lags depression symptom improvement that necessitates targeted treatment.  Cognitive work hardening (CWH) is a multi-element, work-oriented intervention with empirical research supporting its role in return-to-work following a depressive episode.  In a case report, these researchers described the use of CWH to prepare an individual to return to work following a disability leave due to depression.  It showed how CWH bridges the functional gap between being home on disability and returning to competitive employment.  The patient presented was a 50-year-old divorced woman who had been off work for approximately 2 years for depression precipitated by the terminal illness of her mother.  She participated in a 4-week CWH program that addressed fatigue and decreased stamina, reduced cognitive abilities, outdated computer skills, and heightened anxiety.  Work simulations enabled the rebuilding of cognitive abilities with concomitant work stamina; task mastery bolstered self-confidence and feelings of self-efficacy; and coping skill development addressed the need for stress management and assertive communication strategies.  By program completion, the patient's self-reported work ability had increased and both fatigue and depression symptom severity had decreased.  Clinical markers of work performance indicated that the patient was ready to return to her pre-disability job.  Three months after completion of CWH, the patient reported that she was at work, doing well and working full days with good stamina and concentration.  The authors concluded that this study provided insight into how CWH could be used to return-to-work preparation following depression with positive outcomes.

The authors stated that as is often the case with single-case studies, limitations of this report included the lack of generalizability, inability to show cause and effect, and the danger of over interpretation of a single case.  That said, the case report is a strong vehicle to present the novel (CWH) approach, offer a valuable in-depth lens into CWH, and complement the empirical research.  With respect to the intervention itself, incorporating targeted standardized cognitive tests may be a useful complement to the current measures and tools already in place.  These researchers stated that future studies on other CWH interventions would enhance the understanding of this intervention and further establish its role in RTW; moreover, longer follow up is needed to determine the more long-term effects of CWH.


The above policy is based on the following references:

  1. American Occupational Therapy Association. Work hardening guidelines (position paper). Am J Occup Ther. 1986;40(12):841-843.
  2. 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.
  3. Brewer CC, Storms BS. The final phase of rehabilitation: Work hardening. Orthop Nurs. 1993;12(6):9-15.
  4. 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.
  5. King PM. Outcome analysis of work-hardening programs. Am J Occup Ther. 1993;47(7):595-603.
  6. Lechner DE. Work hardening and work conditioning interventions: Do they affect disability? Phys Ther. 1994;74(5):471-493.
  7. 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.
  8. 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.
  9. 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.
  10. Weir R, Nielson WR. Interventions for disability management. Clin J Pain. 2001;17(4 Suppl):S128-S132.
  11. Wisenthal A. Case report: Cognitive work hardening for return-to-work following depression. Front Psychiatry. 2021;12:608496.
  12. Wyman DO. Evaluating patients for return to work. Am Fam Physician. 1999;59(4):844-848.