Does Medicare Cover Hyperbaric Oxygen Therapy
- During hyperbaric oxygen therapy, an individual receives pure oxygen while in a pressurized chamber. Learn whether Medicare covers hyperbaric oxygen therapy.
Although hyperbaric oxygen therapy is commonly known as a remedy for decompression sickness in divers, it’s also used as part of a comprehensive treatment plan for various illnesses and injuries. During treatment, which is considered safe and painless, an individual sits or lies in a pressurized chamber, where 100% oxygen is administered to promote healing.
When considered medically necessary, hyperbaric oxygen therapy may be covered under Medicare, but certain conditions may apply. Here’s what you need to know about the uses of hyperbaric oxygen therapy and Medicare’s coverage rules.
Who Qualifies for Hyperbaric Oxygen?
Individuals may qualify for hyperbaric oxygen therapy if they have stubborn wounds or bacterial infections, particularly if the affected tissue is starved for oxygen or if the condition hasn’t responded to conventional treatments. However, because the FDA regulates both hyperbaric chambers and the oxygen used in them, as of 2021, the agency has currently only approved the therapy as treatment for the following conditions:
- Severe anemia
- Gas gangrene
- Crush injuries
- Radiation injuries
- Non-healing wounds
- Large or severe burns
- Decompression sickness
- Carbon monoxide poisoning
- Air/gas bubbles in the bloodstream
- Severe skin and bone infections
- Skin grafts at risk of necrosis
- Sudden hearing or vision loss
Studies for the use of this treatment in other medical conditions, such as COVID-19, are ongoing, and guidelines for therapy are likely to change.
Who Isn't a Candidate for Hyperbaric Oxygen Therapy?
Although hyperbaric oxygen therapy is generally considered to be a low-risk procedure, individuals with the following contraindications may not be good candidates for treatment:
- Upper respiratory infection
- Uncontrolled hypertension
- Congenital spherocytosis
- Chronic sinus conditions
- Recent eye surgery
- Recent thoracic surgery
- Seizure disorders
- Pacemakers and other implantable biomedical devices
What Are the Benefits of Hyperbaric Oxygen Therapy?
Hyperbaric oxygen therapy creates conditions that let a person’s lungs take in more oxygen than they normally can. This oxygen, which is delivered through the bloodstream to tissues throughout the body, helps destroy bacteria and stimulates the release of stem cells and growth factors, which promote healing. Repeated treatments may also promote continued normal oxygen levels in body tissue, even after treatment is complete.
Do You Need a Prescription for Hyperbaric Oxygen Therapy?
Yes, hyperbaric oxygen therapy uses medical-grade oxygen, which is classified as a drug under federal law and must be prescribed by an MD, DO or DDS.
What Can You Expect During Hyperbaric Oxygen Therapy?
Individuals who receive hyperbaric oxygen therapy typically sit or lie in a large chamber or tube that’s pressurized to between 1.5 to 3 times normal air pressure with 100% oxygen. In some cases, treatment may be administered in a multi-person chamber, where individuals receive pure oxygen directly through a hood or mask.
During the session, individuals may be asked to take deep breaths to ensure optimal results. Many treatment centers play music designed to relax patients during therapy, and individuals may read a book or magazine to pass the time.
The procedure is painless and has a low risk of complications. However, some individuals may experience a feeling of fullness in their ears, which is caused by the pressure changes. This discomfort can typically be relieved using techniques similar to those airplane passengers use when during landing, such as chewing gum or forcefully swallowing.
Depending on the condition being treated, individuals may need as many as 40 treatments to receive the maximum therapeutic benefit. Each session can last for up to 2 hours, and outpatient treatment is typically administered once daily, up to five times weekly. The number of sessions may be adjusted based on an individual's clinical response to treatment.
How Do You Prepare for Hyperbaric Oxygen Therapy?
Hyperbaric oxygen therapy requires minimal preparation. Prior to entering the treatment chamber, patients are typically asked to change into scrubs or a hospital-approved gown, remove contact lenses and wash off any petroleum-based skin and hair care products. Your therapeutic team may provide additional instructions.
When Does Medicare Cover Hyperbaric Oxygen Therapy?
Medicare may cover hyperbaric oxygen therapy if it’s prescribed for any of the following conditions:
- Gas embolism
- Gas gangrene
- Crush injuries
- Cyanide poisoning
- Decompression sickness
- Soft tissue radionecrosis
- Chronic refractory osteomyelitis
- Acute traumatic peripheral ischemia
- Progressive necrotizing infections
- Acute carbon monoxide intoxication
- Acute peripheral arterial insufficiency
- Lower-extremity diabetic wounds considered Wagner grade III or higher
In some cases, hyperbaric oxygen therapy may be covered when used alongside conventional treatments. However, in other cases, such as the treatment of chronic refractory osteomyelitis, therapy may only be reimbursable if conventional treatment hasn’t been successful. Hyperbaric oxygen therapy may also be covered when used during the suturing of severed limbs or to help prepare or preserve compromised skin grafts.
What Medicare Coverage Rules Apply to Hyperbaric Oxygen Therapy?
For therapy to be reimbursable under Medicare Part B or Medicare Advantage, treatment must be deemed medically necessary by a plan-approved physician and delivered on an outpatient basis in a hyperbaric chamber or tube at a Medicare-approved facility. Individuals who are already hospitalized for their condition may receive hyperbaric oxygen therapy on an inpatient basis under Medicare Part A or Medicare Advantage. Depending on the individual’s condition and prescribed treatment plan, additional criteria may apply before Medicare approves reimbursement.
How Much Does Medicare Reimburse for Hyperbaric Oxygen Therapy?
If therapeutic criteria are met and treatment is delivered in an outpatient setting, Medicare Part B covers 80% of the cost of hyperbaric oxygen therapy after the plan deductible has been met. If hyperbaric oxygen therapy is used during an inpatient hospital stay, the procedure may be up to 100% reimbursable under Medicare Part A, after the deductible has been met.
Beneficiaries enrolled in a Medicare Advantage plan may have different reimbursement rates. Although these plans are administered by private insurance companies, they must provide, at minimum, the same coverage offered through Medicare Parts A and B. However, because reimbursement rules for MA policies vary by insurer and plan, individuals should contact their plan representative for details about coverage and costs.