Is it reimbursable?

Yes, HBO2 is reimbursable as an outpatient procedure for a number of indications approved by CMS. Private insurers generally follow the CMS criteria and may also reimburse for additional indications. As at January 2005, the indications currently reimbursed by CMS along with the ICD codes are as follows:

Covered Conditions

  1. Acute carbon monoxide intoxication, (ICD-9-CM diagnosis 986).
  2. Decompression sickness, (ICD-9-CM diagnosis 993.2, 993.3).
  3. Gas Embolism, (ICD-9-CM diagnosis 958.0, 999.1).
  4. Gas Gangrene, (ICD-9-CM diagnosis 0400).
  5. Acute traumatic peripheral ischemia, HBO2 is a valuable adjunctive treatment to be used in conjunction with accepted standard therapeutic measures when loss of function, limb, or life is threatened. (ICD-9-CM diagnosis 902.53, 903.01, 903.1, 904.0, 904.41).
  6. Crush injuries and suturing of severed limbs. As in the previous conditions, HBO2 therapy would be a valuable adjunctive treatment when the loss of function, limb or life is threatened. (ICD-9-CM diagnosis 927.00-927.03, 927.09-927.11, 927.20-927.21, 927.8-927.9, 928.00-928.01, 928.10-928.11, 928.20-928.21, 928.3, 928.8-928.9, 929.0, 929.0, 929.9, 996.90-996.99).
  7. Progressive necrotizing infections (necrotizing fasciitis), (ICD-9-CM diagnosis 728.86)
  8. Acute peripheral arterial insufficiency, (ICD-9-CM diagnosis 444.21, 444.22, 81).
  9. Preparation and preservation of compromised skin grafts (not for primary management of wounds), (ICD-9-CM diagnosis 996.52; excludes artificial skin graft).
  10. Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management, (ICD-9-CM diagnosis 730.10-730.19).
  11. Osteoradionecrosis as an adjunct to conventional treatment, (ICD-9-CM diagnosis 526.89).
  12. Soft-tissue radionecrosis as an adjunct to conventional treatment, (ICD-9-CM diagnosis 990).
  13. Cyanide poisoning, (ICD-9-CM diagnosis 987.7, 989.0).
  14. Actinomycosis, only as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment, (ICD-9-CM diagnosis 039.0-039.4, 039.8, 039.9).
  15. Diabetic wounds of the lower extremities in patients who meet the following three criteria:
    1. Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes;
    2. Patient has a wound classified as Wagner grade III or higher; and
    3. Patient has failed an adequate course of standard wound therapy.

    The use of HBO2 therapy is covered as adjunctive therapy only after there are no measurable signs of healing for at least 30-days of treatment with standard wound therapy and must be used in addition to standard wound therapy. Standard wound care in patients with diabetic wounds includes: assessment of a patient's vascular status and correction of any vascular problems in the affected limb if possible, optimization of nutritional status, optimization of glucose control, debridement by any means to remove devitalized tissue, maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings, appropriate off-loading, and necessary treatment to resolve any infection that might be present. Failure to respond to standard wound care occurs when there are no measurable signs of healing for at least 30 consecutive days. Wounds must be evaluated at least every 30 days during administration of HBO2 therapy. Continued treatment is not covered if measurable signs of healing have not been demonstrated within any 30 day period of treatment.

Non-covered Conditions

There are a number of indications listed for which data exist but are not covered under the current Medicare program. Private insurers may, in some situations, reimburse for treatment not accepted under CMS guidelines. In this latter situation it is necessary to get approval prior to commencing treatment.

Topical application of oxygen

This method of administering oxygen does not meet the definitions of HBO2 therapy as stated in the guidelines. Also, its clinical efficacy has not been established. Therefore, no Medicare reimbursement may be made for the topical application of oxygen.

The CMS listings may be amended from time to time. To check on current rulings please go to the CMS website at: www.cms.hhs.gov/mcd/index_list.asp?list_type=ncd and click on Hyperbaric Oxygen Therapy.

Copyright Life Support Technologies Group Inc, Sept 2012