Hyperbaric treatment is not one of the more common medical procedures out there today. However, it is used to provide treatment for a few different issues. These range from decompression sickness to diabetic wounds to cyanide poisoning.
If you have a condition that this type of treatment can help, a common question you may have is, “does Medicare cover hyperbaric treatment?” In this article, we answer that question in clear, plain English. You will also find the average costs of going to a hyperbaric treatment and other helpful info.
Does Medicare Cover Hyperbaric Treatment?
The short answer is yes; Medicare will cover the cost of a hyperbaric treatment session. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your hyperbaric treatment session. 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 treatment sessions. Parts A and B provides coverage for your hyperbaric treatment session if it is considered medically necessary. Also, the operation must be first ordered by your healthcare provider in order for Original Medicare to provide coverage.
Coverage for hyperbaric oxygen therapy is provided by Medicare Part B. Medicare Part B considers undergoing a hyperbaric treatment medically necessary if it will be used to treat the following 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 (however, you will receive coverage only if you have tried conventional ways to treat this condition that did not work)
- Osteoradionecrosis (this has to be accompanied by conventional treatment)
- Soft tissue radionecrosis (this has to be accompanied by conventional treatment)
- Actinomycosis (this has to be accompanied by conventional treatment, and you will only receive coverage if antibiotics and surgical treatment did not work)
- 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
However, coverage conditions for hyperbaric treatment are different if you live in certain states such as Illinois, Michigan, or New Jersey.
Before Medicare Part B provides coverage for your hyperbaric treatment in the mentioned states, you will need prior authorization. The same conditions are to be followed if your hyperbaric treatment is non-emergency.
Medicare Part B covers 80 percent of the costs of hyperbaric treatment. You will pay for the remaining 20 percent as coinsurance.
Part C Coverage for Hyperbaric Treatment
Medicare Advantage plans (Medicare Part C) also provide coverage for hyperbaric treatment. They cover everything Original Medicare covers, as well as some additional benefits. However, exactly what it covers and what your out-of-pocket costs will be vary depending on the specifics of your plan.
How Much Does Hyperbaric Treatment Cost?
Hyperbaric oxygen therapy can cost somewhere between $100 to over $1,000. This cost will vary depending on the provider and the length of the session.
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 Optune?