Archived Policies - Therapy
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 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.
Coverage will not be allowed for Work Hardening programs as more carefully documented, randomized, controlled studies are needed to support the efficacy of these programs.
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.
Joy JM, Lowy J, et al. Increased pain tolerance as an indicator of return to work in low-back pain injuries after work hardening. Am J Occup Ther (2001 Mar-Apr) 55(2): 200-5.
Pfingsten M, Hildebrandt J. Treatment of chronic low back-pain through intensive activation – an assessment of 10 years. Anasthesiol Intensivmed Notfallmed Schmerzther (2001 Sep) 36(9): 580-9.
A search of the literature was completed through Medline database for a period of January 2000 thru January 2003. No additional information was found.
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