Please see the following link to see the latest trends and tips in Medicare billing and rreimbursement for hyperbaric oxygen therapy.
Medicare coverage policy for
HBO therapy - Coverage Manual 35-10
For purposes of coverage under Medicare,
hyperbaric oxygen (HBO) therapy is a modality in which
the entire body is exposed to oxygen under increased
A. Covered Conditions.--Program reimbursement for HBO
therapy will be limited to that which is administered
in a chamber (including the one man unit) and is limited
to the following conditions:
||1. Acute carbon
monoxide intoxication, (ICD-9 -CM diagnosis 986).
2. Decompression illness, (ICD-9-CM diagnosis 993.2,
3. Gas embolism, (ICD-9-CM diagnosis 958.0, 999.1).
4. Gas gangrene, (ICD-9-CM diagnosis 0400).
5. Acute traumatic peripheral ischemia. HBO therapy
is a valuable adjunctive treatment to be used in
combination with accepted standard therapeutic measures
when loss of function, limb, or life is threatened.
(ICD-9-CM diagnosis 902.53, 903.01, 903.1, 904.0,
6. Crush injuries and suturing of severed limbs.
As in the previous conditions, HBO therapy would
be an adjunctive treatment when loss of function,
limb, or life is threatened. (ICD-9-CM diagnosis
927.09-927.11, 927.20-927.21, 927.8-927.9, 928.00-928.01,
928.10-928.11, 928.20-928.21, 928.3, 928.8-928.9,
929.0, 929.9, 996.90- 996.99.)
7. Progressive necrotizing infections (necrotizing
fasciitis), (ICD-9-CM diagnosis 728.86).
8. Acute peripheral arterial insufficiency, (ICD-9-CM
diagnosis 444.21, 444.22, 444.81).
9. Preparation and preservation of compromised skin
grafts (not for primary management of wounds), (ICD-9CM
diagnosis 996.52; excludes artificial skin graft).
10. Chronic refractory osteomyelitis, unresponsive
to conventional medical and surgical management,
(ICD-9-CM diagnosis 730.10-730.19).
11. Osteoradionecrosis as an adjunct to conventional
treatment, (ICD-9-CM diagnosis 526.89).
12. Soft tissue radionecrosis as an adjunct to conventional
treatment, (ICD-9-CM diagnosis 990).
13. Cyanide poisoning, (ICD-9-CM diagnosis 987.7,
14. Actinomycosis, only as an adjunct to conventional
therapy when the disease process is refractory to
antibiotics and surgical treatment, (ICD-9-CM diagnosis
039.0-039.4, 039.8, 039.9).
B. Noncovered Conditions.--All other indications
not specified under ¡±35-10 (A) are not covered under
the Medicare program. No program payment may be made
for any conditions other than those listed in ¡± 35-10
(A). No program payment may be made for HBO in the treatment
of the following conditions:
decubitus, and stasis ulcers.
2. Chronic peripheral vascular insufficiency.
3. Anaerobic septicemia and infection other than
4. Skin burns (thermal).
6. Myocardial infarction.
7. Cardiogenic shock.
8. Sickle cell anemia.
9. Acute thermal and chemical pulmonary damage,
i.e., smoke inhalation with pulmonary insufficiency.
10. Acute or chronic cerebral vascular insufficiency.
11. Hepatic necrosis.
12. Aerobic septicemia.
13. Nonvascular causes of chronic brain syndrome
(Pick¡¦s disease, Alzheimer¡¦s disease, Korsakoff¡¦s
15. Systemic aerobic infection.
16. Organ transplantation.
17. Organ storage.
18. Pulmonary emphysema.
19. Exceptional blood loss anemia.
20. Multiple Sclerosis.
21. Arthritic Diseases.
22. Acute cerebral edema.
C. Reasonable Utilization Parameters.--Make payment
where HBO therapy is clinically practical. HBO therapy
should not be a replacement for other standard successful
therapeutic measures. Depending on the response of the
individual patient and the severity of the original
problem, treatment may range from less than 1 week to
several months duration, the average being 2 to 4 weeks.
Review and document the medical necessity for use of
hyperbaric oxygen for more than 2 months, regardless
of the condition of the patient, before further reimbursement
D. Topical Application of Oxygen.--This method of administering
oxygen does not meet the definition of HBO therapy as
stated above. Also, its clinical efficacy has not been
established. Therefore, no Medicare reimbursement may
be made for the topical application of oxygen. (Cross
refer: ¡±35-31. )