Hyperbaric Oxygen Therapy Coverage Under Medicare

# 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 increases the amount of oxygen in the blood, which can promote healing and fight infections. HBOT is commonly used to treat conditions such as decompression sickness, serious infections, and wounds that won’t heal as a result of diabetes or radiation injury.

## Does Medicare Cover Hyperbaric Oxygen Therapy?

Medicare does provide coverage for Hyperbaric Oxygen Therapy, but only under specific circumstances. The Centers for Medicare & Medicaid Services (CMS) has established guidelines for when HBOT is considered medically necessary and therefore eligible for coverage.

### Covered Conditions Under Medicare

Medicare Part B typically covers HBOT for the following conditions:

• Diabetic wounds of the lower extremities
• Acute traumatic ischemia (crush injuries)
• Osteomyelitis (bone infections)
• Radiation tissue damage (osteoradionecrosis)
• Gas gangrene
• Carbon monoxide poisoning
• Decompression sickness
• Air or gas embolism

## Medicare Coverage Requirements

For Medicare to cover HBOT, several requirements must be met:

1. The treatment must be prescribed by a Medicare-approved physician
2. The therapy must be administered in a Medicare-approved facility
3. The patient must have one of the approved conditions listed above
4. Documentation must show that other treatments have been tried without success (for chronic conditions)

## Costs and Patient Responsibility

Under Medicare Part B, patients are typically responsible for:

• 20% of the Medicare-approved amount after meeting the Part B deductible
• Any additional charges if the provider doesn’t accept assignment
• Facility fees if treated in a hospital outpatient department

## Finding Approved Providers

To ensure coverage, patients should:

1. Verify that the provider is Medicare-certified
2. Confirm that the facility has the proper accreditation for HBOT
3. Check with their Medicare Advantage plan (if applicable) for any additional requirements

## Appealing a Denial of Coverage

If Medicare denies coverage for HBOT, patients have the right to appeal. The appeals process involves:

• Requesting a redetermination from the Medicare Administrative Contractor
• Submitting additional medical documentation
• Potentially going through multiple levels of appeal

## Conclusion

Hyperbaric Oxygen Therapy can be a valuable treatment for certain medical conditions, and Medicare does provide coverage when specific criteria are met. Patients and their healthcare providers should work together to ensure all requirements are satisfied and proper documentation is submitted to maximize the chances of coverage approval.