CMS approved and reimbursable indications for HBOT.
The following list details the current CMS approved and reimbursable indications for hyperbaric oxygen therapy (HBOT). HBOT 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 care. 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 a least 30 consecutive days. Wounds must be evaluated at least every 30 days during HBOT. Below are the 15 CMS and most 3rd Party Payors approved and reimbursable indications for HBOT which range from the critical care inpatient to the ambulatory care self referral:
- Acute Carbon Monoxide Intoxication
- Decompression Illness
- Gas Embolism
- Gas Gangrene
- Acute traumatic peripheral ischemia. HBOT is a valuable treatment to be used in combination with accepted standard therapeutic measures when loss of function, limb, or life is threatened.
- Crush injuries and suturing of severed limbs. As in the previous conditions, HBOT would be an adjunctive treatment when loss of function, limb, or life is threatened.
- Progressive necrotizing infections (necrotizing fascitis)
- Acute peripheral arterial insufficiency
- Preparation and preservation of compromised skin grafts (not for primary management of wounds)
- Chronic refractory osteomyelitis, unresponsive to conventional treatment
- Osteoradionecrosis as an adjunct to conventional treatment
- Soft tissue radionecrosis as an adjunct to conventional treatment
- Cyanide poisoning
- Actinomycosis, only as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment
- Diabetic wounds of the lower extremities in patients who meet the following criteria: a) Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes, b) Patient has a wound classified as Wagner grade III or higher, and c) Patient has failed an adequate course of standard wound therapy