Archived Policies - Therapy


Work Hardening

Number:THE803.012

Effective Date:09-01-2016

End Date:07-14-2017

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.

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.

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.

2013 Update

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

2015 Update

A search of peer reviewed literature through August 2015 identified no information that would change the coverage position of this medical policy.

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:

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 overage 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

97545, 97546

HCPCS Codes

None

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

Refer to the ICD-10-CM Manual

ICD-10 Procedure Codes

Refer to the ICD-10-CM Manual


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 since this medical policy document was written. See Medicare's National Coverage at <http://www.cms.hhs.gov>.

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—Archived. 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.

Policy History:

DateReason
9/1/2016 Reviewed. No changes.
10/15/2015 Document updated with literature review. No changes.
9/1/2014 Reviewed. No changes.
12/15/2013 Document updated with literature review. Coverage unchanged. CPT/HCPCS codes updated.
3/1/2008 Revised document
3/1/2006 Revised/updated entire document
12/1/2003 Revised/updated entire document
9/1/1996 Revised document
5/1/1996 Revised document
4/1/1993 Revised document
1/1/1993 New medical 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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