Medicare Guidelines for Hyperbaric Oxygen Therapy
Medicare covers hyperbaric oxygen therapy only for specific conditions and injuries, such as carbon monoxide and cyanide poisoning. The therapy must be a supplement to traditional treatment. If you meet all criteria, Medicare pays 80 percent of the cost for each hyperbaric oxygen therapy session you receive.
Is Hyperbaric Oxygen Therapy Covered By Medicare?
Medicare covers hyperbaric oxygen therapy for several conditions, but you must meet certain criteria to qualify.
The therapy must be administered in a chamber — including a one-person unit — in order for you to receive Medicare coverage.
- Acute carbon monoxide intoxication
- Decompression illness
- Gas embolism
- Gas gangrene
- Cyanide poisoning
- Acute traumatic peripheral ischemia
- Crush injuries and suturing of severed limbs
- Progressive necrotizing infections
- Acute peripheral arterial insufficiency
- Preparation and preservation of compromised skin grafts
Medicare also covers hyperbaric oxygen therapy for a handful of other conditions — but only when it’s used as a supplement to conventional treatment.
- Chronic refractory osteomyelitis that is unresponsive to conventional medical and surgical management
- Soft tissue radionecrosis
- Actinomycosis — when the disease process is resistant to antibiotics and surgical treatments
Medicare also covers hyperbaric oxygen therapy if you have wounds on your lower body caused by diabetes. To qualify, your wounds must be classified as Wagner grade III or higher after a course of standard wound therapy has failed to improve your condition.
In most cases, Medicare doesn’t consider hyperbaric oxygen therapy the go-to treatment of choice. Rather, Medicare will pay for this type of supplement, or adjunct, therapy only after 30 days of standard wound therapy has failed to produce measurable signs of healing.
If you participate in hyperbaric oxygen as an adjunct therapy, you must undergo standard wound care at the same time.
Every 30 days, your wounds will be evaluated. Medicare will stop paying for hyperbaric oxygen therapy if you don’t show any measurable signs of healing within any 30-day period you receive the treatment.
Medicare Cost for Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy is covered by Medicare Part B. You will be responsible for 80 percent of the cost. The Part B deductible — $203 in 2021 — also applies.
You may owe less if you have supplement insurance, such as Medicaid or a Medigap policy.
Hyperbaric oxygen therapy typically takes place on an outpatient basis at a hospital or special clinic. You will typically pay more out of pocket if you receive therapy at a hospital.
Your doctor may recommend hyperbaric oxygen therapy for other reasons, but unless you have one of the conditions listed above, Medicare won’t pay for the treatment.
- Skin burns
- Sickle cell anemia
- Organ transplantation
- Pulmonary emphysema
- Exceptional blood loss anemia
- Multiple Sclerosis
- Arthritic diseases
The list above is not exhaustive, so confirm your benefits prior to receiving hyperbaric oxygen therapy.
Medicare also won’t pay for the topical application of oxygen. If you undergo this type of treatment, you will be responsible for 100 percent of the costs.
What Is Hyperbaric Oxygen Therapy?
Hyperbaric oxygen therapy involves breathing pure oxygen in a pressurized environment.
It began as treatment for deep-sea divers suffering from decompression sickness, a painful and potentially deadly condition where gas bubbles accumulate in the blood.
The therapy is now used to treat several conditions, including serious infections and wounds resulting from diabetes or radiation injury that that fail to heal.
During a hyperbaric session, patients lie on a bed in an enclosed tube containing high-pressure oxygen while a physician supervises.
Breathing 100 percent oxygen inside a pressurized chamber increases the amount of oxygen in a patient’s blood.
Increased oxygen levels in the blood are said to promote the growth of new blood vessels into the hypoxic tissues and enhance the body’s ability to kill certain bacteria.
The therapy often requires multiple sessions, each lasting about two hours. The number of sessions you require depends on your condition.
According to the Mayo Clinic, carbon monoxide poisoning may be treated in just three visits, while other conditions, such as nonhealing wounds, can require more than 40 sessions.
5 Cited Research Articles
- Mayo Clinic. (2020, October 28). Hyperbaric oxygen therapy. Retrieved from https://www.mayoclinic.org/tests-procedures/hyperbaric-oxygen-therapy/about/pac-20394380
- United Healthcare. (2020, October 20). Hyperbaric Oxygen Therapy. Retrieved from https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-coverage-sum/hyperbaric-oxygen-therapy-macs.pdf
- Galewitz, P. (2017, June 28). Medicare flags overuse of hyperbaric therapy for diabetics due to questionable value. Retrieved from https://www.healthcarefinancenews.com/news/medicare-flags-overuse-hyperbaric-therapy-diabetics-due-questionable-value
- Medicare.gov. (n.d.). Hyperbaric oxygen therapy. Retrieved from https://www.medicare.gov/coverage/hyperbaric-oxygen-therapy
- U.S. Centers for Medicare & Medicaid Services. (n.d.). National Coverage Determination (NCD) for Hyperbaric Oxygen Therapy (20.29). Retrieved from https://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?ncdid=12&ver=3