Selected Problem Wounds
Hyperbaric Oxygen Therapy for Non-Healing Wounds
HBOT is an FDA-cleared, UHMS-recognized adjunct for specific kinds of non-healing wounds, including selected diabetic foot wounds, delayed radiation wounds and compromised grafts and flaps. It is not a treatment for every chronic wound. A physician determines which category your wound falls into and whether HBOT belongs in your care.
Understanding Wounds
Why Some Wounds Stop Healing
A healthy wound moves through overlapping stages. First the bleeding stops and inflammation clears out debris and bacteria. Then new tissue fills the gap, with fresh blood vessels and collagen. Finally the wound closes and the new tissue strengthens over months.
A chronic wound gets stuck, usually in the inflammation stage. Clinicians generally call a wound chronic when it has not improved in about four weeks or has not healed in eight to twelve weeks. Common reasons include:
- Low oxygen in the tissue, from narrowed arteries, diabetes or scarring after radiation.
- Infection, including infection that has reached the bone.
- Ongoing pressure on the wound, such as walking on a foot ulcer.
- High blood sugar, which slows the cells that rebuild tissue.
- Smoking, which narrows blood vessels.
- Poor nutrition, especially too little protein.
- Swelling that keeps oxygen and nutrients from reaching the wound.
Fixing the underlying cause always comes first. For some specific wound types, though, oxygen delivery remains the bottleneck even with good care. That is where hyperbaric oxygen therapy (HBOT) may have a role. To understand the physics behind it, read how HBOT raises tissue oxygen.
The Basics
How HBOT May Support Healing in Non-Healing Wounds
Enhancement of healing in selected problem wounds is a UHMS-recognized indication. The FDA has cleared hyperbaric chambers for select non-healing diabetic wounds of the lower extremities, delayed radiation injury, and compromised grafts and flaps. The word "selected" is important: this is not a blanket clearance for all wounds.
During HBOT you breathe near-100% oxygen in a chamber pressurized to at least 2.0 times normal atmospheric pressure. Much more oxygen dissolves into your blood plasma, and it can travel into tissue that is poorly supplied. Over a course of sessions, in the right wound, HBOT may support:
- New blood-vessel growth (angiogenesis) into the wound bed.
- Collagen production by fibroblasts, the cells that rebuild tissue.
- White blood cell activity, since the way these cells kill bacteria depends on oxygen.
- Less swelling, because high oxygen levels narrow blood vessels slightly while still delivering more oxygen.
Does HBOT help wounds heal faster?
For selected cleared wound types, trials have reported higher healing rates over a course of HBOT compared with standard care alone. The clearest data come from diabetic foot ulcers, summarized on our page about HBOT for diabetic foot ulcers. HBOT is not a general wound accelerator, though, and it is not a shortcut around wound care. It is used as an adjunct, meaning it is added to good wound care rather than used instead of it.
Candidacy
Who Is a Candidate? Which Wounds Are Cleared Indications
The first question your physician asks is what kind of wound you have. The answer decides whether HBOT is a recognized option at all. This table summarizes the official lists.
| Wound type | Cleared or recognized? | Notes |
|---|---|---|
| Diabetic lower-extremity wound | Yes | Medicare criteria: Wagner grade 3 or higher and at least 30 days of standard care without measurable healing. |
| Radiation wounds (delayed soft-tissue injury) | Yes | For damage that appears months or years after radiation therapy. |
| Compromised grafts and flaps | Yes | For grafts or flaps that are failing, not routine surgical recovery. Time-sensitive. |
| Wound with bone infection beneath it (chronic refractory osteomyelitis) | Yes | When infection persists after surgery and antibiotics. |
| Acute traumatic or acute arterial ischemia | Yes | Usually an emergency managed in hospital settings. |
| Post-surgical wound that won't close | Depends | Evaluated case by case. It may qualify only if it fits one of the categories above, such as a wound in irradiated tissue. |
| Venous stasis ulcer | No | Not an FDA-cleared indication as such. Listed as non-covered by Medicare. |
| Pressure (decubitus) ulcer | No | Not an FDA-cleared indication as such. Listed as non-covered by Medicare. |
| Arterial ulcer without the criteria above | No | Not a cleared indication on its own. Restoring blood flow is the usual priority. |
If your wound falls in a "No" row, HBOT is not a recognized option, and we will tell you so. The care that matters most for those wounds is compression for venous ulcers, pressure relief for pressure ulcers, and a vascular evaluation for arterial ulcers.
Other things your physician considers
- Blood flow. Oxygen still has to reach the wound, so a blocked artery usually needs attention first. Physicians commonly measure oxygen levels in the skin near the wound with a noninvasive test called transcutaneous oximetry (TcPO2). This is a common step in wound evaluation, and our team explains its process at your assessment.
- Infection control and debridement already in place.
- Your overall health, including lungs, ears and medications. See risks and contraindications.
Not sure which category your wound falls into? Call (369) 222-0979 and ask whether your wound qualifies for an assessment.
The Research
What the Evidence Shows
The strength of the evidence depends heavily on the wound type. That is one reason the cleared list is narrow. The results below are published findings, not predictions for any individual wound.
| Study | Year | Design | Participants | Finding | Limitation |
|---|---|---|---|---|---|
| Kranke et al., Cochrane review | 2015 | Systematic review of randomized trials in chronic wounds | 12 trials, 577 participants | Diabetic foot ulcer healing improved at 6 weeks, not shown at longer follow-up. Too little evidence to judge venous, arterial or pressure ulcers. | Small trials with varied methods. |
| Löndahl et al., Diabetes Care | 2010 | Double-blind randomized controlled trial | 94 with diabetic foot ulcers | Complete healing at 1 year in 52% with HBOT vs. 29% with placebo. | Single country; patients already in specialist wound care. |
| Systematic review, Plastic and Reconstructive Surgery Global Open | 2026 | Review of 24 comparative studies (13 randomized) | 2,246 | Healing outcomes favored HBOT in soft-tissue injuries needing skin flaps or grafts. | Certainty of evidence rated very low to moderate. |
The UHMS reviews this body of research when it maintains its indications list. Its recognition of "selected problem wounds" reflects benefit in specific, well-defined situations rather than in chronic wounds generally.
Your Plan
What a Course Looks Like
At Generations Wellness, care is directed by Dr. Rajwinder Singh Bahia, MD, and sessions take place in hard-shell monoplace chambers, each holding one person. You breathe medical-grade oxygen at a physician-prescribed pressure while staff stay in communication with you.
- Sessions: typically 20 to 40, usually once a day, five days a week.
- Session length: about 90 to 120 minutes including pressurization and depressurization.
- Pressure: commonly 2.0 to 2.5 ATA for wound indications.
- Progress checks: wound measurements and photos are reviewed regularly, and at least every 30 days. A course continues only when the wound is measurably improving.
- Ongoing wound care: dressings, debridement and offloading continue with your current providers.
For a walk-through of a visit, read what to expect at your first session.
Safety
Risks and Contraindications
HBOT is generally well tolerated under supervision, but it is a medical treatment with side effects. The most common is ear or sinus pressure (barotrauma). Others include temporary nearsightedness that usually resolves after the course, tiredness, and confinement anxiety. People with diabetes can see blood sugar drop during sessions.
Serious complications are rare. Oxygen-toxicity seizures occur in roughly 1 in 5,000 to 10,000 treatments. The only absolute contraindication is an untreated collapsed lung. Some chemotherapy drugs, certain lung conditions, seizure disorders, recent ear surgery and implanted devices need physician review. Read more about HBOT safety and screening.
Paying for Care
Cost and Insurance for Non-Healing Wounds
Generations Wellness currently offers HBOT on a self-pay basis. We do not bill insurance, Medicare or Medi-Cal today while we work toward insurance contracts.
In general, whether insurance may cover HBOT for a wound depends on the wound's category. Medicare's NCD 20.29 covers diabetic lower-extremity wounds that meet its criteria, soft-tissue radionecrosis as an adjunct, compromised skin grafts, chronic refractory osteomyelitis and certain acute ischemic conditions. The same policy lists cutaneous, decubitus (pressure) and stasis ulcers as non-covered. Commercial and Medicare Advantage plans commonly follow similar lists and often require prior authorization. At facilities that bill Medicare, patients typically pay the Part B deductible ($283 in 2026) and then 20% coinsurance.
Published national self-pay ranges for medical-grade HBOT at independent centers run about $150 to $450 per session. These are ranges, not quotes, and we review pricing for your physician-recommended plan clearly at your consultation. If you may qualify for coverage elsewhere, ask us and we'll explain your options honestly. Learn more about HBOT cost, insurance coverage for HBOT and Medicare's HBOT criteria.
Modesto & the Central Valley
Wound Care in Modesto: How HBOT Fits In
People with chronic wounds in Modesto, Stockton, Turlock, Manteca and Merced are often already seeing a hospital wound program, a community wound clinic, a podiatrist or a vascular surgeon. Those providers handle the core of wound care: debridement, offloading, compression, dressings, infection control and vascular procedures. HBOT is one tool among these, useful only for selected wounds.
With your permission, our physician coordinates with the providers already treating you, so HBOT supports their plan. Wound-care teams can refer a wound-care patient or call to talk through a case.
Important
A physician assessment is required before beginning HBOT at Generations Wellness. HBOT complements, and never replaces, the treatment prescribed by your doctors. A wound with spreading redness, fever or a foul smell needs prompt medical care.
Questions
Non-Healing Wounds and HBOT: Frequently Asked Questions
Does hyperbaric oxygen therapy help wounds heal faster?
For selected cleared wound types, it may support healing over a 20- to 40-session course as an adjunct to standard wound care. It is not a general accelerator for every wound.
Which non-healing wounds qualify for HBOT?
Selected diabetic lower-extremity wounds (Wagner grade 3 or higher), delayed radiation wounds, compromised grafts and flaps, wounds over refractory bone infection, and certain acute ischemic wounds. Venous, pressure and most arterial ulcers are not cleared indications.
How many HBOT sessions are needed for wound healing?
Typically 20 to 40 daily sessions, with physician reassessment at least every 30 days. The course continues only if the wound is measurably improving.
Do I need to stop my other wound care?
No. HBOT is added to debridement, offloading, dressings and infection control, and with your permission we coordinate with your wound clinic.
Is HBOT for wounds covered by insurance?
Insurance may cover cleared wound categories when criteria are met, but Medicare lists venous and pressure ulcers as non-covered. Generations Wellness currently offers self-pay care only, and we'll explain your options honestly.
Sources
- StatPearls. Hyperbaric Therapy for Wound Healing. ncbi.nlm.nih.gov
- Kranke P, et al. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews. 2015. cochranelibrary.com
- Löndahl M, et al. Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care. 2010. pmc.ncbi.nlm.nih.gov
- Systematic Review of Comparative Studies Evaluating Hyperbaric Oxygen Therapy on Skin Flap and Graft Surgical Indications. Plastic and Reconstructive Surgery Global Open. 2026. pmc.ncbi.nlm.nih.gov
- Centers for Medicare & Medicaid Services. National Coverage Determination 20.29, Hyperbaric Oxygen Therapy. cms.gov
- Undersea and Hyperbaric Medical Society. Hyperbaric Oxygen Therapy Indications. uhms.org
- U.S. Food and Drug Administration. Hyperbaric Oxygen Therapy: Get the Facts. fda.gov
- StatPearls. Hyperbaric Complications. ncbi.nlm.nih.gov
- MedlinePlus. Wounds and Injuries. medlineplus.gov
This page is educational and not medical advice. Study results describe published research, not expected outcomes. A physician assessment is required before HBOT. See our full medical disclaimer.
Your Next Step
Begin With a Physician Assessment
Every course starts with an honest conversation and a physician assessment. No pressure, no obligation.
Prefer to talk? (369) 222-0979