BlueCross and BlueShield of Montana Medical Policy/Codes
Work Hardening
Chapter: Therapies
Current Effective Date: February 15, 2014
Original Effective Date: July 18, 2013
Publish Date: January 15, 2014
Revised Dates: January 15, 2014
Description

Work hardening is a highly specialized rehabilitation program that spans the transition from traditional rehabilitation therapies to return to work by simulating workplace activities and surroundings in a monitored environment. Programs may be developed and carried out by an occupational therapist and/or physical therapist. The goal is to create an environment in which returning workers can rebuild psychological self-confidence and physical reconditioning by replicating their work routine.

Policy

Each benefit plan or contract defines which services are covered, which are excluded, and which are subject to dollar caps or other limits.  Members and their providers have the responsibility for consulting the member's benefit plan or contract to determine if there is any exclusion or other benefit limitations applicable to this service or supply.  If there is a discrepancy between a Medical Policy and a member's benefit plan or contract, the benefit plan or contract will govern.

Coverage

Work hardening programs are considered not medically necessary, as they are for the purpose of conditioning for a return to work and not for the treatment of a medical condition.

Rationale

Work hardening programs are considered not medically necessary, as they are for the purpose of conditioning for a return to work and not for the treatment of a medical condition.

2014 Update

There is no new information that would change the coverage position of this medical policy.

Coding

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps. 

ICD-9 Codes

Not medically necessary for all diagnoses.

ICD-10 Codes

Not medically necessary for all diagnoses.

Procedural Codes: 97545, 97546
References
  1. Joy, J.M., Lowy, J., et al.  Increased pain tolerance as an indicator of return to work in low-back pain injuries after work hardening.  American Journal of Occupational Therapy (2001 March-April) 55(2): 200-5.
  2. Pfingsten, M., and J. Hildebrandt.  Treatment of chronic low back-pain through intensive activation – an assessment of 10 years. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie (2001 September) 36(9): 580-9.
  3. Schonstein, E., Kenny, D.T., et al.  Work conditioning, work hardening and functional restoration for workers with back and neck pain.  Cochrane Database System Review (2003) (1):CD001822
  4. Work Hardening.  Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual. (2003 April)  Therapy 8.03.06.
  5. Koopman, F.S., Edelaar, M., et al.  Effectiveness of a multidisciplinary occupational training program for chronic low back pain:  a prospective cohort study.  American Journal of Physical Medicine and Rehabilitation (2004 February) 83(2): 94-103.
  6. Wilson, K.B.  Vocational rehabilitation acceptance in the USA:  controlling for education, type of major disability, severity of disability and socioeconomic status.  Disability and Rehabilitation (2004 February 4) 26(3): 145-56.
  7. De Buck, P.D., Breedveld, J., et al.  A multidisciplinary job retention vocational rehabilitation program for patients with chronic rheumatic diseases:  patients’ and occupational physicians’ satisfaction.  Annals of the Rheumatic Diseases (2004 May) 63(5): 562-8.
  8. Nathell, L.  Effects on sick leave of an inpatient rehabilitation programme for asthmatics in a randomized trial.  Scandinavian Journal of Public Health (2005) 33(1): 57-64.
  9. Sang, L.S., and L.P.Ying Eria.  Outcome evaluation of work hardening program for manual workers with work-related back injury.  Work (2005) 25(4):297-305
  10. de Buck, P.D.,  le Cessie, S. et al.  Randomized comparison of a multidisciplinary job-retention vocational rehabilitation program with usual outpatient care in patients with chronic arthritis at risk for job loss.  Arthritis Rheumatism (2005 Oct 15) 53(5):682-90.
  11. Baker, P., Goodman, G., et al.  The effectiveness of a comprehensive work hardening program as measured by lifting capacity, pain scales, and depression scores.  Work (2005) 24(1):21-31.
  12. Baker, P., Goodman, G., et al.  The effectiveness of a comprehensive work hardening program as measured by lifting capacity, pain scales, and depression scores.  Work (2005) 24(1): 21-31.
  13. Bonde, J.P., Rasmussen, M.S., et al.  Occupational disorders and return to work:  a randomized controlled study.  Journal of Occupational Rehabilitation (2005 July) 37(4): 230-5.
  14. Beutel, M.E., Zwerena, R., et al.  Vocational training integrated into inpatient psychosomatic rehabilitation—short and long-term results from a controlled study.  Disability and Rehabilitation (2005 August) 27(15): 891-900.
  15. van den Hout, W.B., de Buck, P.D., et al.  Cost-utility analysis of a multidisciplinary job retention vocational rehabilitation program in patients with chronic arthritis at risk of job loss.  Arthritis and Rheumatism (2007 Jun 15) 57(5):778-86.
History
 July 2013 New 2013 BCBSMT medical policy.  Work hardening programs are considered not medically necessary, as they are for the purpose of conditioning for a return to work and not for the treatment of a medical condition. 
February 2014 Document updated with literature review. Coverage unchanged. CPT/HCPCS codes updated.  Removed CPT 97537.
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Work Hardening