Covered Conditions
Medicare's National Coverage Determination 20.29 lists the conditions for which HBOT is covered. For wound care practices the most common is diabetic wounds of the lower extremity that meet specific criteria, including a Wagner grade III or higher classification and failure of standard wound therapy. Other covered conditions include chronic refractory osteomyelitis, osteoradionecrosis, soft tissue radionecrosis, compromised skin grafts and flaps, and several acute conditions.
HBOT for conditions not on the list is not covered, and MACs may issue additional billing and coding guidance that defines the documentation they expect.
Physician And Facility Billing
The supervising physician reports CPT 99183 for attendance and supervision of each session. The hospital outpatient department reports the facility service with HCPCS G0277 per 30-minute interval. Physician office HBOT is uncommon under Medicare rules, and most wound care physicians bill their supervision while a hospital bills the facility component.
Documentation For Continued Treatment
Reviewers expect the record to show that the patient met the coverage criteria at the start and that treatment continues to be reasonable. For diabetic lower extremity wounds, Medicare requires evidence of measurable signs of healing during a 30-day period of treatment to support continuation.
- Diagnosis and the specific covered indication
- Wagner grade for diabetic wounds and the prior standard care tried
- Physician presence and supervision for each session
- Session pressure, duration and the patient's tolerance
- Wound measurements and progress at regular intervals
Frequently Asked Questions
- Is HBOT covered for a venous leg ulcer?
- Venous ulcers are not among the covered indications in NCD 20.29. Coverage for HBOT is limited to the conditions in the NCD.
- What happens if the wound is not improving?
- For diabetic lower extremity wounds, Medicare does not cover continued HBOT when there are no measurable signs of healing within a 30-day treatment period. The physician's note should address this directly.
Billing Support For This Specialty
Physicians Professional Billing Services, Inc. has billed wound care, surgical and procedural specialties since 1998, across every Medicare Part B MAC jurisdiction.
Primary Sources
This page is general information about billing and coverage rules and is not legal, coding or reimbursement advice for a specific claim. Coverage policies change; confirm current requirements with CMS and the applicable Medicare Administrative Contractor.