Coverage for Hyperbaric Oxygen Therapy

(HBO Therapy) (99183)

*Adapted from Medicare B Update Newsletter Special Issue, October 1996

Background: In keeping with national guidelines form the Health Care Financial Administration, medical policy has been revised for procedure code 99183 (Physician attendance and supervision of hyperbaric oxygen therapy.)

Covered Conditions and/or Diagnoses

Medicare of Florida will consider Hyperbaric Oxygen Therapy (CPT code 99183) medically reasonable and necessary under the following circumstance:

  • Hyperbaric Oxygen Therapy is a valuable adjunctive treatment to be used in combination with accepted standard therapeutic measures, when loss of function, limb, or life in threatened.
  • HBO therapy should not be a replacement for other standard successful therapeutic measures; however, it is the treatment of choice and standard care for decompression sickness and arterial gas embolism. Traumatic or spontaneous pneumothorax constitute contraindication to HBO therapy only if untreated and pregnancy is considered a contraindication to HBO except in the case of carbon monoxide poisoning where it is specifically indicated.
  • Topical application of oxygen (Topox) is noncovered.
  • Arterial insufficiency ulcers may be treated by HBO therapy is they are persistentt after reconstructive surgery has restored large vessel function. HBO therapy for venous stasis ulcers is recommended only if venous surgery, local wound care by elevation, counter pressure support and skin grafting fails.
  • Evaluation and management services and/or procedures (e.g. wound debridement) provided in a hyperbaric oxygen treatment facility in conjunction with a hyperbaric oxygen therapy session may be reported separately.
Indications of effective treatment outcomes for HBO include:
- There is improvement or healing of wounds.
- There is improvement of tissue perfusion.
- There is new epithelial tissue growth and granulation.
- Tissue PO2 of at least 30mHg of oxygen is necessary for oxidative function to occur.
- The mechanical reduction in the bubble size of air emboli alleviates decompression sickness.

The following diagnoses reflect the indications for which the services is considered medically necessary:

039.0-039.9 903.01 927.9 987.7
040.0 904.0 928.00-928.01 989.0
444.21-444.22 904.41 928.10-928.11 990
526.89 927.00-927.09 928.20-928.21 993.3
686.0 927.10-927.11 928.8-928.9 993.9
733.40 927.20-927.21 958.0 996.52
909.2 927.8 986 999.1

Noncovered Conditions and/or Diagnoses

No program payment may be made for HBO in the treatment of the following conditions:

  • Cutaneous, decubitus, and stases ulcers
  • Chronic peripheral vascular insufficieny
  • Anaerobic septicemia and infection other than clostridial
  • Skin burns (thermal)
  • Senility
  • Myocardial infarction
  • Cardiogenic shock
  • Sickle cell crisis
  • Acute thermal and chemical pulmonary damage, i.e. smoke inhalation with pulmonary insufficiency
  • Hepatic necrosis
  • Aerobic septicemia
  • Nonvascular causes of chronic brain syndrome (Pick's disease, Alzheimer's disease, Korsakoff's disease)
  • Tetanus
  • Systemic aerobic infection
  • Organ transplantation
  • Organ storage
  • Pulmonary emphysema
  • Exceptional blood loss anemia
  • Multiple sclerosis
  • Arthritic diseases
  • Acute cerebral edema

Subject to Waiver

Diagnosis

Yes (with the exception of the non-covered conditions and/or diagnoses for which no program payment may be made.)

Utilization

Yes

Comments

Documentation Requirements

Documentation for all services should be maintained on file in the event of a postpayment audit (e.g., progress notes and treatment record) to substantiate medical necessity for HBO treatment.

If treatment exceeds established parameters, acceptable diagnoses for coverage and progress notes indicating the need for continued treatment should be submitted.