CommercialCoverageHigh impact
Work Hardening Programs (CPB 0198, reviewed 2026-03-24)
Aetna·Physical Therapy, Occupational Therapy, Orthopedics +2 more·Medical Policy
Effective date
Feb 3, 1998
We identified it
Aug 14, 2026
Summary
Aetna CPB 0198 confirms non-coverage of work hardening programs, community/work reintegration training, and back school programs, classifying them as vocational training rather than medical treatment. Billing teams must deny claims for CPT codes 97537, 97545, 97546, and HCPCS code S9117 when submitted for these indications, and must educate providers that these services are not covered benefits.
Action Required
Immediately: (1) Billing team must configure denial rules in billing software to automatically reject claims for CPT codes 97537, 97545, 97546, and HCPCS code S9117 when submitted under Aetna plans. (2) Add these codes to internal 'non-covered services' list with notation 'vocational training - not covered.' (3) Notify all in-network providers in writing that work hardening programs, work reintegration training, and back school programs are not covered by Aetna and should not be billed. (4) Update encounter forms and clinical documentation templates to flag these services as non-billable for Aetna patients. (5) Train front desk and scheduling staff to inform patients that these services are not covered benefits before services are rendered. Failure to implement denials will result in write-offs and potential provider relations issues. This policy is effective since 1998 but was reviewed 03/24/2026, confirming continued non-coverage.