Hyperbaric Oxygen Therapy for Chronic Refractory Osteomyelitis

What "refractory" means

Refractory osteomyelitis is bone infection that persists or comes back after appropriate treatment, meaning surgical debridement to remove infected and dead bone plus a proper course of antibiotics chosen from culture results. HBOT is considered for this stubborn form of the infection, not as a first step for a new one.

Where it commonly occurs

• The diabetic foot. Deep foot ulcers often reach bone. See diabetic foot osteomyelitis.
• Long bones after injury or surgery, such as the shin bone after a fracture or around orthopedic hardware.
• The breastbone (sternum) after heart surgery.
• The jaw, sometimes overlapping with osteoradionecrosis of the jaw after radiation.
• The spine or pelvis, less commonly.

Orthopedic and infectious-disease specialists often describe chronic osteomyelitis using a staging system such as Cierny-Mader, which considers how much bone is involved and the patient's overall health. These details help the team decide on surgery, antibiotics and whether HBOT may add value.

Who is usually not a candidate

• People with a new, uncomplicated bone infection that has not yet had standard treatment.
• People without a surgical and antibiotic plan in place, since HBOT is only an adjunct.
• People with an untreated collapsed lung, or other safety concerns your physician identifies. See HBOT safety.

Your physician determines whether HBOT is appropriate after reviewing your imaging, culture results, surgical history and current antibiotics. If an infection sits under a wound that won't close, see non-healing wound over infected bone. To ask whether HBOT fits your infection plan, call (369) 222-0979.

At Generations Wellness, care is directed by Dr. Rajwinder Singh Bahia, MD. Sessions take place in hard-shell monoplace chambers, each for one person, where you breathe medical-grade oxygen at a physician-prescribed pressure while staff stay in communication with you.

• Number of sessions: typically 20 to 40.
• Frequency: 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, as prescribed by your physician.
• Timing: ideally started soon after surgical debridement, while culture-directed antibiotics continue.
• Follow-up: your specialists track progress with exams, lab tests and imaging.

If you are on IV antibiotics through a PICC line, tell us. The line and any dressings are reviewed for chamber safety. To picture a typical visit, read what to expect at your first session.

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, and we say so plainly before you begin.

In general, this is one of the indications insurance may cover. Original Medicare's NCD 20.29 covers "chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management." Your records usually need to show that surgery and antibiotics have already been tried. At facilities that bill Medicare, patients typically pay the Part B deductible ($283 in 2026) and then 20% coinsurance, which published estimates put at roughly $90 to $115 per session. Commercial and Medicare Advantage plans commonly require prior authorization.

Published national self-pay ranges for medical-grade HBOT at independent centers run about $150 to $450 per session, and a 20- to 40-session course adds up. These are ranges, not quotes. We review pricing for your physician-recommended plan clearly at your consultation. If you likely qualify for coverage, ask us and we'll explain your options honestly. See Medicare coverage for refractory osteomyelitis and HBOT cost per session and per course.