Archived Policies - Therapy


Work Hardening

Number:THE803.012

Effective Date:03-01-2008

End Date:12-14-2013

Coverage:

This medical document is no longer scheduled for routine literature review and update.

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.

Description:

Work hardening is a highly structured, goal oriented, individualized treatment program designed to maximize a 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.

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.

Contract:

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.

Coding:

None

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. 

CPT/HCPCS/ICD-9/ICD-10 Codes

The following codes may be applicable to this Medical policy and may not be all inclusive.

CPT Codes

97537, 97545, 97546

HCPCS Codes

 

ICD-9 Diagnosis Codes

Refer to the ICD-9-CM manual

ICD-9 Procedure Codes

Refer to the ICD-9-CM manual

ICD-10 Diagnosis Codes

 

ICD-10 Procedure Codes

 


Medicare Coverage:

The information contained in this section is for informational purposes only.  HCSC makes no representation as to the accuracy of this information.  It is not to be used for claims adjudication for HCSC Plans.

The Centers for Medicare and Medicaid Services (CMS) does not have a national Medicare coverage position.  Coverage may be subject to local carrier discretion.

A national coverage position for Medicare may have been developed or changed since this medical policy document was written.  See Medicare's National Coverage at <http://www.cms.hhs.gov>.

References:

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., 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.

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

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., 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.

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.

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

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.

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

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.

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

Policy History:

3/1/2008          This policy is no longer scheduled for routine literature review and update.

3/1/2006          Revised/updated entire document

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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