Medicare's Coverage for Hyperbaric Oxygen Therapy

Medicare does cover hyperbaric oxygen therapy, but only for specific conditions and only when your doctor orders it as medically necessary. The therapy must take place in a hospital outpatient department or an approved facility — not at home. Medicare Part B pays 80 percent of the approved amount after you meet your deductible, and you pay the remaining 20 percent.

The conditions Medicare covers are narrow. The main ones are diabetic wounds of the lower extremities, severe anemia, bone infections that have not responded to other treatment, burns, problem wounds after radiation therapy, and sudden hearing loss or vision loss caused by air or gas bubbles in blood vessels. Your doctor must document that the therapy is medically necessary for your specific condition, and the facility must be Medicare-certified.

Key Takeaways

  • Medicare covers hyperbaric oxygen therapy only for a limited list of conditions, with diabetic foot wounds being the most common reason for approval.
  • Your doctor must order the therapy and the facility must be Medicare-certified; home use is not covered.
  • You pay 20 percent of the Medicare-approved cost after meeting your Part B deductible; the exact amount depends on your facility and treatment plan.
  • Before starting treatment, ask your doctor to confirm Medicare will cover it for your condition, because coverage denials are common for conditions outside the approved list.

The Conditions Medicare Will Pay For

Medicare has a specific list of diagnoses for which hyperbaric oxygen therapy is considered medically necessary. Diabetic wounds of the foot or lower leg are by far the most common reason Medicare approves the therapy. The wound must be present for at least 30 days and not be healing with standard care before your doctor can order hyperbaric treatment.

The other covered conditions are less common but include severe anemia when blood transfusion is not an option, bone infections (osteomyelitis) that have not responded to antibiotics or surgery, thermal burns, wounds that will not heal after radiation therapy for cancer, and sudden sensorineural hearing loss or vision loss caused by decompression sickness or arterial gas embolism. Your doctor must document that your specific condition meets Medicare's definition and that hyperbaric oxygen therapy is the appropriate next step.

If your condition is not on this list, Medicare will deny the claim. Some people pursue the therapy anyway and pay out of pocket, but this is expensive — a typical course of 30 to 40 sessions can cost several thousand dollars.

Where You Can Receive Treatment

Hyperbaric oxygen therapy must be delivered in a hospital outpatient department or a freestanding facility that is Medicare-certified. You cannot receive covered treatment at home, even if a home unit is available. The facility must meet specific safety and staffing standards, and the doctor ordering the treatment must be credentialed to do so at that location.

Before your first appointment, confirm with the facility that they are Medicare-certified and that they have submitted your case for pre-authorization. Some facilities handle this step automatically; others require your doctor's office to submit the paperwork. If pre-authorization is not obtained before treatment begins, Medicare may deny the entire claim, leaving you responsible for the full cost.

What You Will Pay

Your out-of-pocket cost depends on whether you have met your Part B deductible for the year. Once you have paid the deductible (which is $240 in 2024, though this amount changes yearly), Medicare pays 80 percent of the approved amount and you pay 20 percent. The approved amount is set by Medicare, not by the facility's stated price.

A typical course of hyperbaric oxygen therapy involves 30 to 40 sessions, usually given five days a week for six to eight weeks. Each session lasts about two hours, though only part of that time is spent in the chamber. The Medicare-approved cost per session varies by location and facility type, but you should expect to pay roughly $100 to $300 per session out of pocket after your deductible is met. Ask the facility for an estimate based on your specific treatment plan before you start.

If you have a Medigap or Medicare Advantage plan, your additional coverage may reduce your 20 percent cost share. Check your plan documents or call your plan to understand what you will owe.

How to Get Medicare Approval Before Treatment Starts

Do not begin hyperbaric oxygen therapy without confirming that Medicare will cover it. The process starts with your doctor, who must order the treatment and document the medical reason. Your doctor's office or the facility itself will then submit a request for pre-authorization to Medicare.

Medicare reviews the request to confirm that your diagnosis is on the covered list and that the documentation supports medical necessity. This review usually takes one to two weeks. If Medicare approves, you will receive a notice and can begin treatment. If Medicare denies the request, you have the right to appeal, and your doctor can provide additional documentation to support the appeal.

Some facilities will begin treatment while waiting for Medicare's decision, but this is risky — if Medicare denies coverage, you become responsible for all costs. It is safer to wait for approval in writing before your first session.

What Happens If Medicare Denies Your Claim

If Medicare denies coverage for your condition, you have several options. The first is to ask your doctor to appeal the decision by submitting additional medical records or a letter explaining why hyperbaric oxygen therapy is necessary in your case. Medicare's initial decision is not always final, and some appeals succeed.

If the appeal is also denied, you can request an independent review by a may have access to independent contractor (QIC), which is a separate entity that reviews Medicare decisions. This process takes longer but may overturn the denial. Your doctor or the facility can help you understand the appeal process and what documentation to submit.

If you decide to pursue treatment despite Medicare's denial, you will pay the full cost yourself. Some people do this, particularly if their condition is not on Medicare's list but their doctor believes the therapy may help. Before making this decision, ask the facility for a written cost estimate and confirm that you understand you will not be reimbursed by Medicare.

Medicare Advantage Plans and Hyperbaric Oxygen Therapy

If you have a Medicare Advantage plan instead of Original Medicare, your coverage for hyperbaric oxygen therapy may differ. Most Medicare Advantage plans follow Medicare's rules for covered conditions, but some plans may have additional restrictions or require prior approval from the plan itself, not just from Medicare.

Before scheduling treatment, contact your Medicare Advantage plan directly to confirm coverage. Ask whether the facility you plan to use is in-network and whether the plan requires pre-authorization. Some plans require you to use specific facilities or may deny coverage for conditions that Original Medicare would cover.

Frequently Asked Questions

Can I get hyperbaric oxygen therapy at home if Medicare covers it?

No. Medicare only covers hyperbaric oxygen therapy delivered in a hospital outpatient department or a Medicare-certified freestanding facility. Home use is not covered under any circumstances, even if your doctor prescribes it and even if you own a home chamber.

How long does Medicare approval take?

Pre-authorization review usually takes one to two weeks. Some facilities expedite the process if the medical need is urgent, but you should not assume approval will come quickly. Plan ahead and do not begin treatment while waiting for the decision.

What if my doctor says I need hyperbaric oxygen therapy but my condition is not on Medicare's list?

You can ask your doctor to appeal to Medicare with documentation of medical necessity, but approval is unlikely if your condition is not on the covered list. If you choose to pursue treatment anyway, you will pay the full cost yourself. Discuss the cost and likelihood of success with your doctor before deciding.

Will my Medigap plan pay the 20 percent I owe?

Most Medigap plans cover the 20 percent coinsurance for Medicare-covered services, but the specific coverage depends on your plan. Check your plan documents or call your Medigap insurer to confirm what they will pay for hyperbaric oxygen therapy.

Do I need to go to a specific facility, or can I choose any certified center?

You can choose any Medicare-certified facility, but if you have a Medicare Advantage plan, you may be required to use in-network providers. Check your plan's provider directory or call the plan before scheduling to confirm the facility is covered.