# Hyperbaric Oxygen Therapy Coverage Under Medicare

## Understanding Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric Oxygen Therapy (HBOT) is a medical treatment that involves breathing pure oxygen in a pressurized chamber. This therapy has been used to treat various conditions, including decompression sickness, non-healing wounds, and certain infections. The increased pressure allows your lungs to gather more oxygen than would be possible at normal air pressure, which helps fight bacteria and stimulate the release of substances called growth factors and stem cells, which promote healing.

## Does Medicare Cover Hyperbaric Oxygen Therapy?

Medicare does provide coverage for HBOT, but only for specific medically necessary conditions that have been approved by the Centers for Medicare & Medicaid Services (CMS). Coverage is typically available under Medicare Part B (Medical Insurance) when the treatment is administered in an outpatient setting.

### Approved Conditions for HBOT Coverage

Medicare covers HBOT for the following conditions when deemed medically necessary:

• Acute carbon monoxide intoxication
• Decompression sickness (the bends)
• Gas embolism
• Gas gangrene
• Acute traumatic peripheral ischemia
• Crush injuries and other acute traumatic ischemias
• Enhancement of healing in selected problem wounds
• Necrotizing soft tissue infections
• Osteomyelitis (refractory)
• Delayed radiation injury (soft tissue and bony necrosis)
• Compromised grafts and flaps
• Acute thermal burn injury

## Medicare Part B Coverage Details

For approved conditions, Medicare Part B typically covers 80% of the Medicare-approved amount for HBOT after you meet your Part B deductible. You’re responsible for the remaining 20% coinsurance unless you have supplemental insurance (Medigap) or other secondary coverage.

### Facility Requirements

Medicare only covers HBOT when performed in:

• Hospital outpatient departments
• Critical access hospitals
• Medicare-certified independent freestanding hyperbaric facilities

## What’s Not Covered by Medicare?

Medicare does not cover HBOT for conditions not on the approved list, including but not limited to:

• Autism
• Alzheimer’s disease
• Multiple sclerosis
• Sports injuries
• Anti-aging treatments

## How to Get HBOT Covered by Medicare

To ensure coverage:

1. Your doctor must confirm you have an approved condition
2. Treatment must be medically necessary
3. Services must be provided by a Medicare-approved facility
4. Proper documentation must be submitted

## Appealing a Medicare Denial

If your HBOT claim is denied, you have the right to appeal. The appeals process typically involves:

1. Requesting a redetermination from your Medicare Administrative Contractor (MAC)
2. If denied again, requesting reconsideration by a Qualified Independent Contractor (QIC)
3. Further appeals to an Administrative Law Judge if necessary

## Conclusion

While Medicare does cover Hyperbaric Oxygen Therapy for specific conditions, it’s important to understand the coverage limitations and requirements. Always consult with your healthcare provider and Medicare representative to confirm coverage before beginning treatment. For the most current information, visit the official Medicare website or contact Medicare directly.