Hyperbaric Oxygen Therapy is an increasingly popular treatment for a number of medical conditions.
These include: burns, skin grafts, soft tissue injuries, infections in the skin and bones, severe anemia, radiation injury, and even non-healing wounds.
During Hyperbaric Oxygen Therapy a person goes into a chamber where the air pressure is increased to two to three times higher than normal. This allows your lungs to gather more oxygen which aids in the healing process. It can take place in a multi-person chamber or individual unit.
Since this is a therapy can treat many health conditions, a common question many people have is, “does Medicare cover Hyperbaric Oxygen Therapy?” In this article, we answer that question in clear, plain English. You will also find the average costs of hyperbaric oxygen therapy, as well as other helpful info.
Does Medicare Cover Hyperbaric Oxygen Therapy?
The short answer is yes; Medicare will cover the cost of hyperbaric oxygen therapy. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your hyperbaric oxygen therapy. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for hyperbaric oxygen therapy. Coverage for hyperbaric oxygen therapy is provided by Medicare Part B.
However, for Medicare Part B to cover your hyperbaric oxygen therapy, it has to be medically necessary. For the treatment to be considered medically necessary, your hyperbaric oxygen therapy must be for treating one of these medical conditions:
- Acute carbon monoxide poisoning
- Decompression sickness
- Cyanide poisoning
- Crush injury
- Compromised skin grafts
- Gas embolism
- Gas gangrene
- Acute traumatic peripheral ischemia
- Acute peripheral arterial insufficiency
- Progressive necrotizing infections
- Chronic refractory osteomyelitis, but only if you have tried conventional ways to treat it and it did not work
- Osteoradionecrosis, but it has to be accompanied by conventional treatment
- Soft tissue radionecrosis, but it has to be accompanied by conventional treatment
- Actinomycosis, but has to be accompanied by conventional treatment, and if antibiotics and surgical treatment did not work
- Diabetic wounds of the lower extremities
- If you have type 1 or 2 diabetes and have a lower extremity wound caused by your diabetes
- Your wound is classified as Wagner grade III or higher
- Standard wound therapy is not enough to treat your wound
When Oxygen Treatment Is Not Covered
However, if you reside in Illinois, Michigan, or New Jersey, or if your hyperbaric oxygen therapy is non-emergency, you will need to get authorization from Medicare for them to cover the cost of your treatment.
Once approved by Medicare Part B, they will cover 80% of the cost of your hyperbaric oxygen therapy. You will pay for the remaining 20%
Medicare Advantage plans (Medicare Part C) also provide coverage for hyperbaric oxygen therapy. They cover everything Original Medicare covers as well as some additional benefits. However, out-of-pocket costs will vary depending on the specifics of your plan.
How Much Does Hyperbaric Oxygen Therapy Cost?
Hyperbaric oxygen therapy can anywhere between $100 to over $1,000. Having hyperbaric oxygen therapy in an HBOT clinic is generally cheaper. There it typically costs around $100. If you get it while in a large medical hospital, it can cost $1,000 or more.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover weight loss programs?