Archived Policies - Therapy

Work Hardening


Effective Date:03-01-2006

End Date:02-29-2008


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.


Work hardening is a highly structured, goal oriented, individualized treatment program designed to maximize the person’s ability to return to work.  Work hardening programs are multidisciplinary in nature with the capability of addressing the functional, physical, behavioral, and vocational needs of the person served.  Work hardening provides a transition between the initial injury management and return to work, while addressing the issues of productivity, safety, physical tolerance, and work behavior.  Work hardening programs use real or simulated work conditions in a relevant work environment in conjunction with physical conditioning tasks if necessary.  The activities are used to progressively improve bio-mechanical, neuromuscular, cardiovascular-metabolic, behavioral, attitudinal, and vocational functions of the person served.


Physical conditioning programs that include a cognitive-behavioral approach plus intense physical training that includes aerobic capacity, muscle strength and endurance, and coordination; are in some way work related; and are given and supervised by a physiotherapist or a multidisciplinary team; seem to be effective in reducing the number of sick days for some workers with chronic back pain, when compared to usual care.  However, there is no evidence of their efficacy for acute back pain.


Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions. Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions 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, summary plan description or contract, the benefit plan, summary plan description or contract will govern.



Medicare Coverage:

Centers for Medicare and Medicaid Services (CMS) do not have a national position on this service. It is subject to local carrier discretion. Please refer to the local carrier for more information.


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.

Pfingsten, M., Hildebrandt, J., Treatment of chronic low back-pain through intensive activation – an assessment of 10 years. Anasthesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie (2001 September) 36(9): 580-9.

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.

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.

De Buck, P.D., 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.

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.

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.

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.

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.

Schonstein, E., Kenny, D.T., et al.  Work conditioning, work hardening and functional restoration for workers with back and neck pain.  Cochrane Review (2005) Issue 4 The Cochrane Library.

Policy History:

Archived Document(s):

Title:Effective Date:End Date:
Work Hardening07-15-201706-14-2018
Work Hardening09-01-201607-14-2017
Work Hardening10-15-201508-31-2016
Work Hardening09-01-201410-14-2015
Work Hardening12-15-201308-31-2014
Work Hardening03-01-200812-14-2013
Work Hardening03-01-200602-29-2008
Work Hardening12-01-200302-28-2006
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