Work Hardening

Work-hardening programs help workers restore function so that they can successfully return to work.

The basics about work-hardening in Washington State

Work-hardening programs or services are:

• Made up of real or simulated work tasks, conditioning exercises, and education used to restore physical, behavioral, and vocational functions.
• Highly-structured, multi-disciplinary, and individualized for each worker.
• Delivered in a 4-week program that begins at 4 hours a day and progresses up to 8 hours 3-5 times per week.
• Delivered only by approved providers.

More detail is available under work-hardening programs standards.

Getting approval

The work-hardening program requires:

• Referral from the worker's attending provider and
• Prior authorization by the claim manager.

Extending the work-hardening program

• Program extensions beyond 4 weeks must be authorized in advance by the claim manager and are based on documentation of progress and the worker's ability to benefit from the program extension.

Questions regarding Washington State's L&I Work Hardening program?

Contact Sarah Martin, Therapy Services Coordinator, at Sarah.Martin@Lni.wa.gov or 360-902-4480.

Approved Providers for Work Hardening

Approved Work Hardening Provider Directory
Washington Providers
Aberdeen. Arlington. Belfair. Bellevue Bremerton. Clarkston. East Wenatchee.	Everett. Federal Way. Grandview. Hoquiam. Kennewick. Kent. Lakewood.	Longview. Lynnwood. Moses Lake. Mount Vernon. Mountlake Terrace. Olympia.	Othello. Pasco. Puyallup. Renton. Seattle. Sedro Woolley.	Spokane. Tacoma. Tumwater. Vancouver. Yakima. Zillah.
Idaho Providers		Oregon Providers
Boise.		Milton-Freewater, and Portland, and Astoria..

Not approved? Find out how to become a work hardening provider for workers covered under WA State L&I.

Washington Providers
Aberdeen
Harbor Physical Therapy 220 W First ST Aberdeen, WA 98520	Phone: 360-533-3853 Fax: 360-533-3310.
Arlington
Human Performance in Industry 19007 61st Avenue NE, Ste 5 Arlington, WA 98223	Phone: 360-435-8989 Fax: 360-403-8347.
Belfair
Belfair PT 70 NE Medical Center Road PO Box 637 Belfair, WA 98528	Phone: 360-275-4352 Fax: 360-275-5692.
Bellevue
United Backcare 2515 140th Ave NE, Suite 110 Bellevue, WA 98005	Phone: 425-644-4110 Fax: 425-644-4101.
Bremerton
MVP Bremerton 4060 Wheaton Way, Suite C, Bremerton, WA 98310	Phone: 360-479-8477 Fax: 360-479-8417.
Clarkston
Clarkston Physical Therapy 1366 Bridge Street Clarkston, WA 99403	Phone: 509-751-1780 Fax: 509-751-8771.
East Wenatchee
Associates in Physical Therapy, PLLC 230 Grant Road, Suite B-27 East Wenatchee, WA 98802	Phone: 509-884-1437 Fax: 509-884-2811.
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Everett
RPT EPI Rehab 11627 Airport Road, Ste H Everett, WA 98204	Phone: 425-353-9300 Fax: 425-290-3688.
VibrantCare Rehab ONSITE Boeing 3003 West Casino Road Everett, WA 98203	Phone: 425-342-4790 Fax: 425-342-4845.
HPI - Everett 2615 W Casino Road, Ste 3J Everett, WA 98204	Phone: 425-513-2555 Fax: 425-513-0886.
United Backcare 607 SE Everett Way, Ste B & C Everett, WA 98208	Phone: 425-513-8509 Fax: 425-290-9774.
Federal Way
Highline Therapy Services 1010 S 336th ST, Ste 112 Federal Way, WA 98003	Phone: 253-661-0041 Fax: 253-661-0772.
Grandview
Grandview Physical Therapy 214 Ash Street Grandview, WA 98930	Phone: 509-882-3111 Fax: 509-882-3362.
Hoquiam
Hoquiam Therapy Services 501 8th Street Hoquiam, WA 98550	Phone: 360-532-0544 Fax: 360-532-0559.
Kennewick
Gale Physical Therapy & Sports Rehab 7513-A W Kennewick Avenue Kennewick, WA 99336	Phone: 509-735-4343 Fax: 509-736-5414.
Columbia Physical Therapy 907 S Auburn Kennewick, WA 99336	Phone: 509-582-0429 Fax: 509-582-1182.
Kent
People's Injury Network Northwest 20640 84th Avenue S Kent, WA 98032	Phone: 253-395-1131 Fax: 253-395-1171.
Apple Physical Therapy 25012 104th Avenue SE Ste C Kent, WA 98030	Phone: 253-856-3477 Fax: 253-856-3478.
Lakewood
MVP Hand Therapy and Work Rehab 7308 Bridgeport Way W, Ste 203 Lakewood, WA 98499	Phone: 253-582-8500 Fax: 253-582-8506.
Longview
PT Northwest of Longview 1560 3rd Avenue Longview, WA 98632	Phone: 360-423-9535 Fax: 360-414-9284.
Peace Health St Johns Outpatient Therapies 852 Commerce Avenue Longview, WA 98632	Phone: 360-501-3750 Fax: 360-501-3755.
Lynnwood
NW Return to Work and Evaluation Services 19231 36th Avenue West, Suite K Lynnwood, WA 98036	Phone: 425-774-9564 Fax: 425-775-9634.
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Moses Lake
Moses Lake Sports Physical Therapy 515 N Stratford Road Moses Lake, WA 98837	Phone: 509-766-4277 Fax: 509-766-4280.
Columbia Physical Therapy, Inc 1342 S Pioneer Way Moses Lake, WA 98837	Phone: 509-765-9608 Fax: 509-766-0481.
Mount Vernon
NW Phys Ther Sports Rehab Center 110 N LaVenture Road, Ste A Mount Vernon, WA 98273	Phone: 360-428-2700 Fax: 360-428-2701.
Mountlake Terrace
WorkAble Solutions 6601 220th Street SW, Ste 1 Mountlake Terrace, WA 98043	Phone: 425-775-7274 Fax: 425-775-0963.
Olympia
South Sound Therapy Services 1651 Cooper Point Rd SW, Bldg 2 Olympia, WA 98502	Phone: 360-956-1100 Fax: 360-956-1113.
Othello
Columbia PT 116 S 1st Ave Othello, WA 99344	Phone: 509-488-0773 Fax: 509-488-0818.
Pasco
Columbia PT & Sports Rehab 1632 W Court Street Pasco, WA 99301	Phone: 509-547-3636 Fax: 509-545-5095.
Washington Physical Therapy Services 3807 W Court Street Pasco, WA 99301	Phone: 509-547-3725 Fax: 509-547-9852.
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Puyallup
Meridian Physical Therapy 1707 3rd Street SE Puyallup, WA 98372	Phone: 253-841-3041 Fax: 253-841-3061.
Olympic Sports/Spine Rehab 8011 112th Street Court E Puyallup, WA 98373	Phone: 253-848-0662 Fax: 253-848-8567.
United Backcare Puyallup 126 15th Street SE Puyallup, WA 98372	Phone: 253-445-8663 Fax: 253-445-8342.
Renton
Vibrant Care Rehab Onsite - Boeing 737 Logan Avenue Renton, WA 98057	Phone: 425-342-4790 Fax: 425-342-4845.
Valley Medical Center 400 S 43rd Street PO Box 50010 M/S NWP002 Renton, WA 98058	Phone: 425-352-5165 Fax: 425-656-4028.
Seattle
Columbia Physical Therapy 3207 Rainier Ave S Seattle, WA 98144	Phone: 206-722-2205 Fax: 206-722-5457.
Rehabilitation Institute of WA 415 1st Ave N, Ste 200 Seattle, WA 98108	Phone: 206-859-5030 Fax: 206-859-5031.
Sedro Woolley
Cascade PT & Sports Clinic 210 Ferry Street Sedro Woolley, WA 98284	Phone: 360-856-4216 Fax: 360-856-4217.
Spokane
Therasport Northwest 124 E Rowan Avenue, Ste 202 Spokane, WA 99207	Phone: 509-484-0095 Fax: 509-484-0477.
St Luke's Rehabilitation Inst 711 S Cowley Street, Ste 310 Spokane, WA 99202	Phone: 509-473-6943 Fax: 509-473-6097.
Summit Rehab-Valley 12509 E Mission, Ste 202 Spokane, WA 99216	Phone: 509-444-5678 Fax: 509-343-5678.
Summit Rehabilitation Associates 407 E Second Avenue, Suite 100 Spokane, WA 99202	Phone: 509-455-6002 Fax: 509-747-5990.
Momentum Physical Therapy & Industrial Rehab 4305 East Trent, Ste 100 Spokane, WA 99212	Phone: 509-535-6050 Fax: 509-535-6051.
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Tacoma
Olympic Sports/Spine - Tacoma 7727 40th Avenue W, Ste A University Place, WA 98466	Phone: 253-460-1362 Fax: 253-460-6628.
People's Injury Network Northwest 6704 Tacoma Mall Blvd, Suite 100 Tacoma, WA 98409	Phone: 253-475-7466 Fax: 253-475-7469.
Performance Work Rehab 2006 112th St E Tacoma, WA 98445	Phone: 253-548-8400 Fax: 253-537-3150.
OT Department St Joseph Medical Center 1617 South J Street, MS 08-06 Tacoma, WA 98401	Phone: 253-426-6685 Fax: 253-426-4337.
Tumwater
Olympia Physical Therapy 2755 Mottman Road SW Tumwater, WA 98512	Phone: 360-352-5077 Fax: 360-352-5022.
People's Injury Network 2120 Mottman Road SW Tumwater, WA 98512	Phone: 360-357-7466 Fax: 360-357-1151.
Vancouver
People's Injury Network Northwest 2501 SE Columbian Way, Suite 120 Vancouver, WA 98661	Phone: 360-260-7466 Fax: 360-260-7485.
PeaceHealth SW Medical Center 200 NE Mother Joseph PL, Suite 100 Vancouver, WA 98664	Phone: 360-514-1623 Fax: 360-514-3155.
Yakima
Northwest Work Options 307 South 3rd Ave Yakima, WA 98902	Phone: 509-469-9240 Fax: 509-469-9258.
Cascade Summit Physical Therapy 3901 Creekside Loop, Ste 102 Yakima, WA 98902	Phone: 509-249-8704 Fax: 509-249-8706.
The Springs - YVMH 302 South 10th Ave Yakima, WA 98902	Phone: 509-574-3300 Fax: 509-574-3315.
Central WA Physical Therapy 1127 Tieton Drive Yakima, WA 98902	Phone: 509-469-7474 Fax: 509-469-7575.
Zillah
Zillah Physical Therapy 513 1st Ave #101 Zillah, WA 98953	Phone: 509-829-5230 Fax: 509-865-5269.
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Idaho providers
Boise
St Luke's / Idaho Elks Rehab Services 600 N Robbins Road, Suite 101 Boise, ID 83702	Phone: 208-489-5030 Fax: 208-489-4064.
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Oregon providers
Astoria
Pacific NW Occupational Therapy 1396 Duane ST Astoria, OR 97103	Phone: 503-325-8115 Fax: 503-325-8212
Milton-Freewater
Premier Physical Therapy 1020 S Main Street Milton-Freewater, OR 97862	Phone: 541-938-2028 Fax: 541-938-2029.
Portland
Providence Worker Rehab Services 507 NE 47th Ave, Ste 110 Portland, OR 97213	Phone: 503-215-4033 Fax: 503-215-4015.
NW Occupational Medical Center 9400 SW Beaverton-Hillsdale Hwy Ste 205 Portland, OR 97005	Phone: 503-684-7246 Fax: 503-624-0724.
Progressive Rehab Assoc 1815 SW Marlow Avenue, Ste 110 Portland, OR 97225	Phone: 503-292-0765 Fax: 503-292-5208.
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Billing for Work Hardening

Fee schedule

Effective July 1, 2012.

Fee Schedule — Reimbursement of services for 4 week program
Code	Description	Unit limit	Unit price	Max price
Local 1001M	Evaluation	6 units (1 unit = 1 hour)	$117.96 /1 hr	$707.76.
CPT™ 97545	Initial first 2 hours per day (if less than 2 hours, see example below)	20 units (1 unit = 2 hours) 1 unit per day, per claimant	$140.56 /2 hr	$2,811.20.
CPT™ 97546	Each additional hour on the same day (if less than 1 hour, see example below)	70 units (1 unit = 1 hour)	$66.41 /1 hr	$4,648.70.
Total	Maximum total — 4 weeks			$8,167.66.

Extending the work hardening program

Program extensions must be authorized in advance by the claim manager and are based on documentation of progress and the worker's ability to benefit from the program extension.

Fee Schedule — Additional 2 week program with prior approval
CPT™ code	Description	Additional unit limit	Additional unit price	Max price
97545	Initial first 2 hours/day	10 units (1 unit = 2 hours)	$140.56 /2 hr	$1,405.60.
97546	Each additional hour on the same day	50 units (1 unit = 1 hour)	$66.41 /1 hr	$3,320.50.
Total	Maximum total - 2 weeks			$4,726.10.

Forms used to bill L&I

• CMS 1500 (F245‑127‑000) - For physical therapists.
• Statement for Miscellaneous Services (F245‑072‑000) - For occupational therapist.
• UB04 (F245‑367‑000) - For hospitals.

Billing examples

Less than 2 hours per day

Less than 2 hours per day does not meet the work hardening program standards and must be billed outside of the work hardening program codes. Use the CPT™ code that appropriately reflects the services provided. Example of less than 2 hours per day:

Less than 1 hour of CPT™ 97546

After the first 2 hours of service on any day (CPT™ 97545), if less than 38 minutes of service is provided.

• The Procedure code CPT™ 97546 must be billed as a separate line item with a -52 modifier.
  AND
• The charged amount is pro-rated to reflect the reduced level of service.
  Example of less than 1 hour of CPT™ 97546:

Billing for services in multi-disciplinary programs

Each provider must bill for the services they are responsible for each day. Both occupational (OT) and physical therapists (PT) may bill for the same date of service.

Only one unit of CPT™ 97545 (first 2 hours) will be paid per day, per claimant. The total number of hours billed should not exceed the hours that the direct services was provided. Example of billing in multi-disciplinary programs:

Billing for additonal services

The work hardening provider can only bill for work hardening services (1001M, CPT™ 97545, 97546) per day, per claimant unless they get prior authorization from the claim manager. Documentation must support the billing of additional services. Example of billing for additional services:

Work Hardening Resources and Frequently Asked Questions

Resources

L&I Work Hardening Program Standards

Rule: Special Programs WAC 296-20-12050

Physical, Occupational, & Massage Therapy website

Job modification

Frequently Asked Questions

• Who provides work hardening programs?

  Approved providers who may be physical therapists, physical therapist assistants, occupational therapists, certified occupational therapy assistants, and Physical Medicine and Rehab board qualified or certified medical or osteopaethic physicians.

  See the list of Approved Providers for Work Hardening or obtain an alternate format by calling the Therapy Services Coordinator at 360 902 4480.

• How does an injured worker enroll in a work hardening program?
  • The attending health care provider must provide a referral for work hardening.
  • Select an approved provider
  • The claim manager must authorize the program in advance
• What is the criteria for admission
  • The worker is able to participate in a progressive rehabilitation program for a minimum of 4 hours a day, 3 to 5 days a week.
  • A specific return to work goal is identified.
  • Ability to benefit from the program based on a screening process.
  • The injury is typically less than 2 years old.
• What is the difference between work hardening and work conditioning?

  Unlike work hardening, L&I has not established standards or a reimbursement schedule unique to work conditioning programs. "Work conditioning" programs are reimbursed as outpatient occupational and physical therapy (OT/PT) under the daily fee cap.

   

  Work Hardening	OT/PT (work conditioning)
  Requires a specific return to work goal.	No specific return to work goal required although goals would focus on increasing physical capacities for work
  Recognized as a specific treatment program by L&I	Not recognized as a specific treatment program by L&I
  Reimbursed according to the work hardening fee schedule.	Reimbursed according to the physical and occupational therapy WAC: For PT, see WAC 296‑23‑220 (www.leg.wa.gov). For OT, see WAC 296‑23‑230 (www.leg.wa.gov).
  Addresses physical, functional, behavioral and vocational needs of the worker.	Addresses physical and functional needs of the worker.
  Multi-disciplinary.	May be provided by one discipline.
  Uses real or simulated work activities with some physical conditioning.	Uses physical conditioning and functional activities related to work.
  Includes education (e.g., body mechanics, work pacing, safety, injury prevention).	May or may not include an educational component.
  Begins at 4 hours/day and builds to 8 hours/day over the course of 4 weeks.	Typically 1-2 hours per day, 3-5 times per week for 4 weeks.

• When is it beneficial to have a vocational provider assigned during work hardening?
  • When there is no job available and a vocational determination is required.
  • To obtain a job analysis
  • To identify a job goal
• If there is an assigned vocational provider, what is thier role?

  The vocational providers may:

  • When there is no job available and a vocational determination is required.
  • Identify potential work hardening candidates.
  • Facilitate referrals to a work hardening program, if approved by the physician and authorized by the claim manager.
  • Explore return-to-work options with workers in order to identify a job goal.
  • Provide a job analysis for the job goal.
  • Assist in the development of job modifications, if appropriate.
  • Communicate with work hardening program staff.
  • Attend conferences as needed.
  • Work with the work hardening team to facilitate a transition to work if appropriate at the completion of the program.

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