Medicare's Coverage of 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 freestanding facility — not at a clinic or wellness center. Medicare will not pay for the treatment if it is performed anywhere else, regardless of the medical reason.

Coverage depends on two things: the condition being treated and whether your doctor has documented that the therapy meets Medicare's medical necessity standard. Even if your condition is on the covered list, Medicare may deny payment if the documentation does not show why this particular patient needs this particular treatment right now.

Key Takeaways

  • Medicare covers hyperbaric oxygen therapy only for 14 specific conditions, including diabetic wounds, radiation injury, and carbon monoxide poisoning.
  • The treatment must be ordered by a physician and performed in a hospital outpatient department or Medicare-approved freestanding facility.
  • Your doctor must document medical necessity in your medical record, and Medicare reviews this documentation before paying.
  • You typically pay 20 percent of the approved amount after you meet your Part B deductible, unless you have supplemental coverage.
  • If Medicare denies the claim, you have the right to request a review, and your doctor can submit additional documentation to support the medical necessity.

The 14 Conditions Medicare Covers

Medicare covers hyperbaric oxygen therapy for these specific diagnoses: acute traumatic wounds, chronic diabetic wounds of the lower extremities, wounds from radiation therapy, wounds from skin grafts or flaps, osteomyelitis (bone infection), necrotizing soft tissue infections, severe anemia, intracranial abscess, chronic refractory osteomyelitis, arterial insufficiency wounds, venous stasis ulcers, pressure ulcers, thermal burns, and carbon monoxide poisoning.

The list is narrow by design. Medicare does not cover hyperbaric oxygen for other conditions — even if your doctor believes it might help or if you have read about it being used elsewhere. If your condition is not on this list, Medicare will not pay, and you would be responsible for the full cost of treatment.

Within each condition, Medicare also requires that the wound or injury meet specific criteria. For example, a diabetic foot wound must be Wagner Grade 3 or higher, meaning it involves the full thickness of skin and extends into deeper tissue. Your doctor's documentation must show that your wound meets these criteria.

How Your Doctor Orders the Treatment

Your physician must order hyperbaric oxygen therapy and document in your medical record why you need it. The order should include the specific diagnosis, the wound stage or severity, how long the treatment is expected to last, and why standard treatment alone is not sufficient. This documentation is what Medicare reviewers will examine.

Your doctor does not need to submit this paperwork to Medicare before treatment begins — treatment can start right away. However, the facility where you receive treatment will submit a claim to Medicare after your sessions are complete. Medicare then reviews the documentation to decide whether to pay.

If you are seeing a wound care specialist or infectious disease doctor in addition to your primary care physician, make sure both providers are aware of the hyperbaric oxygen order. Coordination between providers strengthens the medical record and reduces the chance of a coverage denial.

Where Treatment Must Take Place

Hyperbaric oxygen therapy must be performed in a hospital outpatient department or a freestanding facility that is Medicare-approved. You can ask your doctor or the facility directly whether they are Medicare-approved. If the facility is not approved, Medicare will not pay even if the treatment is medically necessary and the condition is on the covered list.

Hospital outpatient departments are almost always Medicare-approved because they are part of a Medicare-participating hospital. Freestanding hyperbaric centers vary — some are approved and some are not. Before you begin treatment, confirm with the facility's billing department that they are approved to bill Medicare for hyperbaric oxygen therapy.

Treatment at a private wellness clinic, a sports medicine facility that is not hospital-affiliated, or a center that does not participate in Medicare will result in no Medicare payment. You would receive a bill for the full cost of treatment.

What You Pay Out of Pocket

If Medicare approves the claim, you pay 20 percent of the Medicare-approved amount for each treatment session, after you have met your Part B deductible for the year. The deductible amount changes each year — in 2024 it is $240, but you should check the current year's amount on Medicare.gov.

The number of sessions you receive affects your total out-of-pocket cost. Treatment typically involves 20 to 40 sessions, though the exact number depends on your condition and how your wound responds. Each session lasts about two hours, though you spend only 90 minutes in the chamber itself.

If you have a Medigap supplemental insurance plan, it may cover some or all of your 20 percent coinsurance. If you have a Medicare Advantage plan, your costs may be different — check your plan documents or call the plan to find out what you will owe for hyperbaric oxygen therapy.

What Happens If Medicare Denies Your Claim

If Medicare denies payment for your hyperbaric oxygen therapy, you will receive a document called a Medicare Summary Notice (MSN) in the mail. The MSN explains why the claim was denied. Common reasons include: the condition is not on the covered list, the documentation does not show medical necessity, the treatment was not ordered by a physician, or the facility is not Medicare-approved.

You have the right to request a review of the denial. This is called an appeal. You must request the appeal within 120 days of the date on the MSN. You can submit additional medical records, a letter from your doctor explaining why the treatment was necessary, or other documentation that supports your case.

Your doctor can also submit a reconsideration request on your behalf. If your doctor believes Medicare made an error or if new medical information has become available, ask your doctor to contact Medicare with this information. Include specific details about your wound stage, your response to standard treatment, and why hyperbaric oxygen therapy was the appropriate next step.

Questions to Ask Your Doctor

Before you begin hyperbaric oxygen therapy, ask your doctor these questions: Is my condition on Medicare's covered list? What documentation will you include in my medical record to show medical necessity? Where will the treatment take place, and is that facility Medicare-approved? How many sessions do you expect I will need? What is the expected outcome, and how will we measure whether the treatment is working?

Also ask: If Medicare denies the claim, will you help me appeal the decision? Are there any other treatments we should try first, or is hyperbaric oxygen therapy the recommended next step? Will my supplemental insurance or Medicare Advantage plan cover any of the costs I am responsible for?

Frequently Asked Questions

Will Medicare pay for hyperbaric oxygen if I have a wound that is not on the covered list?

No. Medicare covers only the 14 specific conditions listed in its policy. If your condition is not on that list, Medicare will not pay regardless of medical evidence or your doctor's recommendation. You would need to pay out of pocket or explore whether a clinical trial is available for your condition.

Can I get hyperbaric oxygen therapy at a private clinic and bill Medicare myself?

No. Medicare will not pay for treatment at any facility that is not Medicare-approved, and you cannot bill Medicare yourself. Only the facility can submit a claim to Medicare. If you receive treatment at a non-approved facility, you are responsible for the full cost.

How long does it take Medicare to decide whether to pay for my treatment?

Medicare typically processes claims within 30 days of receiving them from the facility. However, if Medicare needs additional documentation from your doctor, the review may take longer. Ask the facility's billing department to contact you if Medicare requests more information.

What if my doctor says hyperbaric oxygen therapy is necessary but Medicare denies it?

Request an appeal within 120 days of the denial notice. Ask your doctor to submit a detailed letter explaining the medical necessity, including your wound stage, your response to other treatments, and why hyperbaric oxygen is appropriate for your specific situation. Your doctor's documentation is often the deciding factor in an appeal.

Does Medicare Advantage cover hyperbaric oxygen therapy differently than Original Medicare?

Medicare Advantage plans must cover at least what Original Medicare covers, but they may have different rules about where treatment can take place or how many sessions are covered. Contact your plan directly to ask about their specific coverage for hyperbaric oxygen therapy before you begin treatment.