# 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 your blood can carry, promoting healing and fighting infections. HBOT has been used to treat various conditions, including:

– Non-healing wounds
– Carbon monoxide poisoning
– Decompression sickness
– Severe anemia
– Certain types of infections

## Medicare Coverage for HBOT

Medicare (specifically Medicare Part B) does cover Hyperbaric Oxygen Therapy, but only for specific FDA-approved conditions. The coverage is subject to certain requirements and limitations that patients should be aware of before pursuing treatment.

### Approved Conditions for Coverage

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

– Diabetic wounds of the lower extremities
– Acute traumatic peripheral ischemia
– Chronic refractory osteomyelitis
– Osteoradionecrosis
– Soft tissue radionecrosis
– Gas gangrene
– Acute carbon monoxide intoxication
– Decompression illness
– Air or gas embolism
– Selected problem wounds

### Coverage Requirements

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

– The treatment must be prescribed by a Medicare-approved physician
– The facility must be Medicare-certified
– The condition being treated must be one of the approved indications
– Documentation must show that other appropriate treatments have been tried without success (for chronic conditions)

## What Medicare Doesn’t Cover

It’s important to note that Medicare does not cover HBOT for:

– Off-label uses not approved by the FDA
– Experimental treatments
– Conditions not listed in their coverage guidelines
– Treatments performed at non-certified facilities

## Costs and Patient Responsibility

Under Medicare Part B:

– You typically pay 20% of the Medicare-approved amount after meeting your Part B deductible
– The Part B deductible applies ($240 in 2024, subject to change annually)
– Some Medicare Advantage plans may offer different cost-sharing arrangements

## Finding a Medicare-Certified HBOT Facility

To ensure coverage, patients should:

– Verify the facility is Medicare-certified
– Confirm the treating physician accepts Medicare assignment
– Check with Medicare or their supplemental insurance provider about specific coverage details
– Obtain prior authorization if required by their specific Medicare plan

## Appealing a Denial of Coverage

If Medicare denies coverage for HBOT that you believe should be covered, you have the right to appeal the decision. The appeals process typically involves:

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

## Staying Informed About Coverage Changes

Medicare coverage policies can change over time. Patients and providers should:

– Regularly check the Medicare website for updates
– Consult with healthcare providers about current coverage guidelines
– Review the Medicare Benefit Policy Manual for the most current information
– Consider consulting with a Medicare specialist for complex cases

Hyperbaric Oxygen Therapy can be a valuable treatment for certain conditions, and understanding Medicare’s coverage policies is essential for patients considering this option. Always verify coverage with Medicare and your healthcare provider before beginning treatment.