If your doctor has advised Hyperbaric Oxygen Therapy for a specific health condition, you must be wondering whether Medicare will provide coverage for it or not. Part B or Original Medicare covers Hyperbaric Oxygen Therapy for certain medical conditions. Find out more about Hyperbaric Oxygen Therapy and when it qualifies for Medicare coverage.
Hyperbaric oxygen therapy (HBOT) is a treatment procedure in which you breathe in pure oxygen in a pressurized environment, reports Mayo Clinic. For this therapy, you enter a special chamber where air pressure is 2-3 times higher than the normal air pressure. The goal is to fill your lungs with oxygen so that your blood can carry more oxygen to your body organs. This helps fight infections and promote healing.
“Hyperbaric oxygen therapy is a treatment used to help heal carbon monoxide poisoning, gangrene, and wounds that won't heal,” Danielle Miura, CFP, a Financial Planner and Founder of Spark Financials, tells WebMD Connect to Care.
According to the Mayo Clinic, some of the other medical conditions where your doctor may advise hyperbaric oxygen therapy include:
- Brain abscess
- Crush injuries
- Air bubbles in blood vessels (arterial gas embolism)
- Decompression sickness
- Anemia due to blood loss
- Skin or bone infection causing dead tissue
- Radiation injury
- Diabetic foot
- Brain injury
- Sudden vision or hearing loss
If you are enrolled in Original Medicare (Part A and Part B), “Hyperbaric Oxygen Therapy can be covered under Original Medicare Part B if used to treat certain approved conditions,” Miura says.
According to the Centers for Medicare & Medicaid Services, the health conditions that may require Hyperbaric Oxygen Therapy and are covered by Medicare Part B are:
- Gas embolism
- Gas gangrene
- Acute carbon monoxide intoxication
- Decompression illness
- Progressive necrotizing infections
- Acute peripheral arterial insufficiency
- Acute traumatic peripheral ischemia
- Crush injuries and suturing of severed limbs
- Osteoradionecrosis as an adjunct to conventional treatment
- Soft tissue radionecrosis as an adjunct to conventional treatment
- Preparation and preservation of compromised skin grafts
- Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management
- Cyanide poisoning
- Actinomycosis, only as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment
- Wounds in your legs due to diabetes if you: have Type 1 or Type 2 diabetes and a lower extremety wound due to diabetes, have a wound classified as Wagner grade III or higher, or have attempted and failed an adequate standard course of wound therapy
“Under Original Medicare (Part A and B), a patient will likely pay 20% of the cost of the treatment plus the Part B deductible,” Miura says. “Medicare can also cover HBOT if used as a supplement to conventional treatment.”
“Medicare may require prior authorization from your doctor before approval for using hyperbaric oxygen therapy,” Lindsay Malzone, Medicare expert for Medigap.com, tells WebMD Connect to Care.
According to the Centers for Medicare & Medicaid Services, if you need hyperbaric oxygen therapy, it can be covered as an adjunctive therapy under Medicare Part B only if your condition does not show any measurable signs of improvement after 30 days of treatment with standard wound therapy and wound care.
Standard wound care for wounds in diabetic patients may include:
- Evaluation of a patient’s vascular status and correcting vascular problems in the affected limb if possible.
- Improvement of nutritional status
- Optimization of blood sugar level
- Debridement by any method to remove dead tissue.
- Maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings.
- Appropriate removal of dead tissue, and necessary treatment for any infection that could be present.
If there are no measurable signs of healing during standard wound care for at least 30 consecutive days, it is considered a failure of treatment. Also, it is important that your diabetic wound should be evaluated at least every 30 days while undergoing HBOT therapy. If you are taking continued HBOT therapy and measurable signs of healing have not been documented within any 30-day period of treatment, your HBOT therapy might not get covered under Part B.
“Depending on your medical condition, it is best to confirm your benefits with your health care provider before receiving hyperbaric oxygen therapy,” Miura says.
Radiation cystitis is a condition in which your urinary bladder gets inflamed as a side effect of radiation therapy used for the treatment of cancers in the lower abdomen (pelvic area). These include cancers of the bladder, colon, rectum, prostate, or uterus, according to the National Library of Medicine. Radiation cystitis occurs due to the exposure of healthy bladder tissue to radiation.
In recent years, hyperbaric oxygen therapy has become more prevalent for the treatment of radiation Cystitis. This therapy both relieves symptoms and slows the progress of the condition.
Radiation cystitis is classified as soft tissue radionecrosis, according to the National Library of Medicine. Since Part B of Original Medicare covers hyperbaric oxygen therapy for soft tissue radionecrosis, it may also cover radiation cystitis.
If you are enrolled in Original Medicare (Part A and Part B), “Medicare covers hyperbaric oxygen therapy for radiation injuries under Part B,” Malzone says. “For a beneficiary enrolled in Original Medicare only, you can expect to pay the Part B deductible, 20% coinsurance, and potentially up to a 15% excess charge.”
“Suppose a Medicare beneficiary is enrolled in a Medicare Supplement plan. In that case, all or a portion of these costs may be covered. This would depend on the plan letter of the beneficiary,” Malzone explains.
If you have Medicare Advantage Plan, “you should review your plan materials for beneficiaries enrolled in Medicare Advantage. Medicare Advantage plans aren't standardized, so each program will have a different cost for the therapy. It would generally apply as outpatient therapy. Contact your plan or review your plan materials for the exact treatment price,” Malzone adds.
“While studies show that hyperbaric oxygen therapy improves depression, neither [Original] Medicare nor Medicare Advantage covers this treatment for individuals suffering only from depression,” Malzone says. “Both Medicare and Medicare Advantage provides various [other] treatment and therapies for beneficiaries suffering from depression.”
Interested in learning more about Medicare, Medigap, and Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.