Billing Requirements for Intermediaries

Follow the general bill review instructions in §3604 of the Medicare Intermediary Manual, Part 3. Claims for HBO therapy should be submitted on Form HCFA-1450 or its electronic equivalent. For specific coverage criteria for HBO Therapy, refer to the National Coverage Determinations Manual, Chapter 1, Section 20.29.

Applicable Bill Types

The applicable bill types are 11X, 13X and 85X.

HCPCS Coding

• 99183 – Physician attendance and supervision of hyperbaric oxygen therapy, per session.

• C1300 – Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval.

NOTE: Code C1300 is not available for use other than in a hospital outpatient department. In skilled nursing facilities (SNFs), HBO therapy is part of the SNF PPS payment for beneficiaries in covered Part A stays.

For hospital inpatients and critical access hospitals (CAHs) not electing Method I, HBO therapy is reported under revenue code 940 without any HCPCS code. For inpatient services, show ICD-9-CM procedure code 93.59 in FL 80 and 81.

For CAHs electing Method I, HBO therapy is reported under revenue code 940 along with HCPCS code 99183.

Payment Requirements for Intermediaries

Payment is as follows:

Intermediary payment is allowed for HBO therapy for diabetic wounds of the lower extremities when performed as a physician service in a hospital outpatient setting and for inpatients. Payment is allowed for claims with valid diagnostic ICD-9 codes as shown above with dates of service on or after April 1, 2003. Those claims with invalid codes should be denied as not medically necessary.

For hospitals, payment will be based upon the Ambulatory Payment Classification (APC) or the inpatient Diagnosis Related Group (DRG). Deductible and coinsurance apply.