CAM 80306

Work Hardening Programs

Category:Therapy   Last Reviewed:November 2019
Department(s):Medical Affairs   Next Review:November 2999
Original Date:November 1996    

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:
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.

Benefit Application
BlueCard®/National Account Issues

Denial of this treatment is applicable for contracts or certificates of coverage that maintain an exclusion for not medically necessary services.

References:

  1. Schonstein E, Kenny DT, Keating J, Koes BW. Work conditioning, work hardening and functional restoration for workers with back and neck pain. Cochrane Database Syst Rev. 2003;(1):CD001822.
  2. Lemstra M, Olszynski WP. The effectiveness of standard care, early intervention, and occupational management in Workers' Compensation claims: Part 2. Spine. 2004;29(14):1573-1579.
  3. American Occupational Therapy Association, Inc. (AOTA).  Functional capacity evaluation.    
  4. American Occupational Therapy Association, Inc. (AOTA).  Occupational therapy services in work rehabilitation; work hardening/work conditioning.  Accessed November 23, 2005. 

Coding Section

Codes Number Description
CPT No Code  
ICD-9 Procedure No Code  
ICD-9 Diagnosis   Not medically necessary for all diagnoses
HCPCS No Code  
ICD-10-CM (effective 10/01/15)   Not medically necessary for all diagnoses
ICD-10-PCS (effective 10/01/15)   Not applicable. ICD-10-PCS codes are only used for inpatient services. Policy is only for outpatient services.
Type of Service Rehabilitation Therapy  
Place of Service Outpatient  

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.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross and Blue Shield Association technology assessment program (TEC) and other non-affiliated technology evaluation centers, reference to federal regulations, other plan medical policies and accredited national guidelines.

"Current Procedural Terminology© American Medical Association.  All Rights Reserved" 

History From 2013 Forward     

11/20/2019 

Annual review, no change to policy intent. 

11/27/2018 

Annual review, no change to policy intent. 

11/15/2017

Annual review, no change to policy intent 

11/01/2016 

Annual review, no change to policy intent. 

10/29/2015 

Annual review, no change to policy intent. 

11/06/2014 

Annual review, added coding section. No change to policy intent. 

11/01/2013

Added Benefit Applications.

 


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