Hyperbaric Oxygen Therapy (HBOT) involves breathing nearly 100% oxygen inside a pressurized chamber, allowing the blood to carry significantly more oxygen to tissues. This therapy promotes healing and fights infection in medical situations where tissue oxygen levels are depleted. Medicare covers HBOT, but coverage is strictly limited to a small list of specific medical conditions defined by federal regulations. This limitation ensures the treatment is covered only when medically necessary and clinically effective for the patient’s diagnosis.
Medicare’s Scope of HBOT Coverage
Medicare’s policy on HBOT is governed by the Centers for Medicare & Medicaid Services (CMS) through a National Coverage Determination (NCD). Regulation NCD 20.29 outlines the precise conditions for which payment is authorized nationwide. This national policy establishes that HBOT is a covered therapeutic service only when administered in a chamber and for the treatment of an approved diagnosis.
The NCD ensures a uniform standard of payment across the country. Coverage is not automatic; it relies entirely on “medical necessity,” meaning a patient’s specific diagnosis and clinical presentation must align exactly with the criteria listed in NCD 20.29.
HBOT is considered an adjunctive therapy, intended for use in combination with accepted standard medical or surgical treatments, not as a standalone cure. This designation reflects the treatment’s role in supporting the body’s healing processes alongside conventional care for life- or limb-threatening conditions. Without a precise diagnosis code that matches an approved condition, Medicare will deny the claim.
Specific Medical Conditions Approved for Coverage
Medicare covers indications including acute, life-threatening emergencies and specific chronic conditions where other therapies have failed.
Acute Conditions
For acute events, coverage is provided for conditions where high-pressure oxygen helps quickly remove toxins or address blockages. These include:
- Acute carbon monoxide intoxication
- Cyanide poisoning
- Decompression illness (“the bends”)
- Arterial gas embolism (blockage of blood flow caused by gas bubbles)
Coverage also extends to severe acute traumatic injuries where HBOT helps save compromised tissue and limbs, such as gas gangrene, crush injuries, and acute traumatic peripheral ischemia. HBOT is used to limit tissue damage and support surgical repairs. For compromised skin grafts, HBOT may be used for preparation and preservation to improve the chance of tissue survival.
Chronic Conditions
Among chronic conditions, coverage is authorized for chronic refractory osteomyelitis (a persistent bone infection unresponsive to conventional management) and osteoradionecrosis (bone tissue death due to radiation damage). The most common chronic indication is a severe diabetic wound of the lower extremity, but only if strict criteria are met. The wound must be classified as Wagner grade III or higher and show no measurable healing after a minimum of 30 consecutive days of standard wound care.
Investigational and Non-Covered Uses
Medicare explicitly denies coverage for many conditions often marketed for HBOT, deeming them “investigational” due to insufficient clinical evidence. Non-covered wounds include cutaneous, decubitus, and stasis ulcers, as they do not meet the specific criteria for diabetic or radiation-related injuries. Medicare also does not cover treatment for chronic peripheral vascular insufficiency or most thermal burns.
A wide range of neurological disorders and chronic illnesses are also non-covered. These include nonvascular causes of chronic brain syndrome (such as Alzheimer’s and senility), multiple sclerosis, and acute cerebral edema. Treatment for conditions like Lyme disease, general anti-aging, or performance enhancement is never covered by Medicare.
Topical oxygen therapy is also not covered, as it does not meet the definition of HBOT. This therapy involves applying oxygen directly to a wound surface rather than pressurizing the entire body in a chamber, and its clinical efficacy is unestablished. If a patient receives HBOT for a non-covered condition, the provider must issue an Advance Beneficiary Notice of Noncoverage (ABN), informing the patient they will be personally responsible for the costs.
Documentation and Facility Requirements for Payment
For a claim to be paid, the facility must meet specific requirements, and the medical record must be documented meticulously. The treatment must be administered in an approved full-body chamber, not a smaller, non-pressurized unit. Supervising physicians must meet specific training standards, often including certification in Undersea and Hyperbaric Medicine.
The patient’s medical chart must include a detailed physician referral and a comprehensive treatment plan supporting the medical necessity for a covered condition. For diabetic wounds, documentation must specifically include the Wagner grade classification and proof that a 30-day course of standard wound care (including debridement, infection control, and appropriate offloading) failed to produce measurable healing. Progress updates and wound evaluations are required at least every 30 days to demonstrate the patient is responding.
If a claim is initially denied, the patient and provider have the right to appeal the decision. This process requires submitting additional documentation to prove medical necessity. The documentation must be clear, legible, and directly link the patient’s condition and the provided therapy to one of the indications listed in NCD 20.29. Failure to provide complete and accurate documentation is a common reason for a claim to remain unpaid.