Emergency Indication
Hyperbaric Oxygen Therapy for Thermal Burns
Serious burns are treated at burn centers, so call 911 for a large, deep or facial burn. Severe thermal burns are an FDA-cleared HBOT indication, but the trial evidence is limited and Medicare does not cover it. Generations Wellness is an outpatient center and does not provide emergency hyperbaric treatment.
This is a medical emergency. Call 911 or go to the nearest emergency room for a large or deep burn; a burn to the face, hands, feet, genitals or a major joint; a burn that circles a limb; any burn with smoke inhalation or trouble breathing; an electrical or chemical burn; or a serious burn in a young child or older adult. While you wait, cool the burn with cool running water, cover it loosely with a clean cloth, and do not apply creams, butter or ice. Emergency hyperbaric treatment is delivered at hospital-based chambers. Generations Wellness is an outpatient center in Modesto and does not provide emergency HBOT.
Burn Centers First
Where Serious Burns Are Treated
Serious burns are best cared for at a burn center, a hospital unit with surgeons, nurses and therapists who specialize in burn care. The American Burn Association's referral criteria describe burns that should be referred to a burn center, including:
- Partial-thickness burns covering more than 10% of the body's surface
- Any full-thickness (third-degree) burn
- Burns to the face, hands, feet, genitals, perineum or major joints
- Inhalation injury from smoke or hot gases
- Electrical burns, including lightning, and chemical burns
- Burns in patients with other serious health conditions or injuries
- Burns in children when the hospital is not equipped to care for children
You do not need to choose a burn center yourself. Call 911. Emergency physicians stabilize the patient and coordinate transfer to a burn center, and to a hospital-based hyperbaric facility if the burn team decides HBOT is indicated. Smoke inhalation can also cause carbon monoxide poisoning, which is covered on our page about carbon monoxide poisoning and HBOT.
The Rationale
Why Burns Are on the HBOT Indication List
"Severe thermal burns" appear on the FDA's list of cleared uses for hyperbaric chambers, and acute thermal burn injury is on the Undersea and Hyperbaric Medical Society (UHMS) indications list. The reasoning comes mostly from animal studies and early human research.
A burn is not uniform. At its center is tissue that is already dead. Around it is a "zone of stasis," tissue that is injured and short of blood flow but could still survive. In the first days, swelling and poor circulation can turn that zone into dead tissue, making the burn deeper and larger. Hyperbaric oxygen is thought to:
- Reduce swelling while still delivering oxygen to injured tissue
- Help preserve small blood vessels in the zone of stasis
- Support white blood cells in fighting infection
Early studies suggested this might reduce fluid needs, surgery and healing time. For those reasons, UHMS materials describe considering HBOT for larger deep burns, or burns to areas like the hands, face or perineum, started early, ideally within about the first 24 hours, as part of hospital burn care. For a plain explanation of the physics, see how hyperbaric oxygen works.
Honest Evidence
What the Evidence Shows
Being on a list is not the same as being well proven. For burns, the evidence is thin, and it is worth saying so plainly.
| Study | Design | Finding | Limitation |
|---|---|---|---|
| Villanueva et al., Cochrane review 2004 | Systematic review; 2 randomized trials | Insufficient evidence to support or refute HBOT for thermal burns; one trial suggested shorter healing time | Very few, small trials with methodological weaknesses |
| Molina-Vega et al., J Burn Care Res 2026 | Systematic review; 13 studies (5 randomized trials, 7 cohort, 1 case-control), 566 burn patients | Possible benefits, including faster wound healing, less surgery and shorter hospital stays | Authors noted variable, inconsistent outcomes that limit firm conclusions, and called for well-designed randomized trials |
In short: HBOT for burns is listed, but not well proven, and it is not a routine part of care at most US burn centers. The decision belongs to the burn team.
Coverage
Coverage Reality for HBOT After Burns
Medicare's National Coverage Determination 20.29 sets out which HBOT uses Medicare covers. Thermal burns are on its non-covered list. Commercial insurance policies vary, and many do not cover HBOT for burns either. Coverage for a burn patient, where it exists, usually runs through a separate covered indication, such as a compromised skin graft or flap.
Generations Wellness currently offers HBOT on a self-pay basis and does not bill insurance or Medicare. For the general rules, read what Medicare covers for HBOT and our guide to commercial coverage.
After the Acute Phase
After the Acute Phase: Grafts and Slow-Healing Burn Wounds
Recovery from a serious burn is long. Follow-up care, led by the burn team, often includes wound care, skin grafting, physical and occupational therapy, scar management, and emotional support for the patient and family.
Two later problems overlap with separate cleared HBOT indications:
- A skin graft or flap that is not taking well. Compromised grafts and flaps are a cleared indication and are on Medicare's covered list. Learn more about compromised skin grafts after burns.
- A wound that will not heal, especially in someone with diabetes or poor circulation. See burn wounds that will not heal.
These are questions for your burn or plastic surgeon to raise first. Every case is different, and HBOT is only ever one part of a wider care plan.
Not a Cleared Use
Burn Scars: Not a Cleared Use for HBOT
Hyperbaric oxygen therapy is not FDA-cleared or UHMS-listed for improving how burn scars look, for scar itching, or for scar tightening (contractures). If you ask us about HBOT for scars, our physician will tell you exactly that. Scar care belongs with your burn team, which may offer pressure garments, silicone sheets, massage and stretching, laser treatment or surgery. Read more about uses that are not cleared.
Generations Wellness
Our Outpatient Role, Honestly
Generations Wellness is a physician-directed outpatient center under Dr. Rajwinder Singh Bahia, MD. We do not provide emergency hyperbaric treatment, and we do not treat acute burns. For a serious burn, call 911.
Once you are stable and home, our team is glad to talk with you. We can answer general questions about hyperbaric oxygen therapy and tell you honestly whether anything we offer is relevant to you, in coordination with your burn team. Burn and plastic surgeons can find information for referring physicians.
Important
Generations Wellness does not provide emergency hyperbaric treatment. A physician assessment is required before beginning any HBOT at our center, and HBOT complements, and never replaces, the treatment prescribed by your doctors.
Questions
Burns and HBOT: Frequently Asked Questions
Is HBOT used for burns?
Severe thermal burns are on the FDA-cleared and UHMS lists, but the trial evidence is limited and most burn centers do not use HBOT routinely.
Does hyperbaric oxygen help burns heal faster?
A Cochrane review found the two small trials insufficient to say, and a 2026 review found possible benefits but inconsistent results. Where it is used, it is started early in hospital burn care.
Does Medicare cover hyperbaric oxygen for burns?
No. Thermal burns are on Medicare's non-covered list for HBOT. Compromised skin grafts and flaps are covered when criteria are met.
Can HBOT improve burn scars?
Scar appearance is not a cleared or listed use, and we do not offer HBOT for it. Your burn team can explain proven scar treatments.
What burns need a burn center?
Large or deep burns; burns to the face, hands, feet, genitals or joints; inhalation, electrical or chemical burns; and serious burns in young children or older adults. Call 911 for any of these.
Sources
- Undersea and Hyperbaric Medical Society. Hyperbaric Oxygen Therapy Indications (acute thermal burn injury). uhms.org
- Villanueva E, et al. Hyperbaric oxygen therapy for thermal burns. Cochrane Database Syst Rev. 2004;CD004727. cochranelibrary.com
- Hyperbaric Treatment of Thermal Burns. StatPearls. ncbi.nlm.nih.gov
- Molina-Vega J, Pferdehirt RE, Vardanian AJ. Hyperbaric Oxygen Therapy in Burn Care: A Systematic Review of Current Evidence. J Burn Care Res. 2026;47(3):917. academic.oup.com
- Centers for Medicare & Medicaid Services. National Coverage Determination 20.29, Hyperbaric Oxygen Therapy. cms.gov
- American Burn Association. Burn Center Referral Criteria. ameriburn.org
- U.S. Food and Drug Administration. Hyperbaric Oxygen Therapy: Get the Facts. fda.gov
This page is educational and not medical advice. For a serious burn, call 911. Generations Wellness does not provide emergency hyperbaric treatment. See our full medical disclaimer, including emergency numbers.
If This Is an Emergency
Call 911 First
Emergency hyperbaric treatment happens in hospital settings. For follow-up questions once you are stable, our team is glad to talk.
Prefer to talk? (369) 222-0979