Refer a Patient for Hyperbaric Oxygen Therapy

Complete records shorten the time to assessment. When we speak, we will arrange a secure way to receive:

• Patient demographics and insurance information (for the record; see coverage status below)
• Diagnosis with ICD-10 code, history and physical
• For wounds: location, measurements, photos, Wagner grade, duration and dates of standard care, vascular studies
• For radiation injury: radiation treatment summary (site, dose, dates) and relevant imaging
• Operative notes for grafts, flaps or debridement
• Cultures, pathology and imaging for osteomyelitis
• Audiogram and onset date for sudden hearing loss
• Full medication list, flagging bleomycin, doxorubicin, cisplatin, disulfiram and mafenide acetate
• Pulmonary history (pneumothorax, COPD with air trapping, bullae) and ear or sinus history
• Seizure history, pregnancy status, and any implanted devices with make and model

Transcutaneous oximetry (TcPO₂) measures periwound oxygen tension and is used in patient selection for wound indications. StatPearls' review of hyperbaric patient selection describes its use in estimating whether a hypoxic wound bed is likely to respond to hyperoxygenation, including in-chamber measurement. If TcPO₂ or other vascular studies are available, please include the results. The physician assessment determines whether further testing is needed before a course is recommended.

Our current status

Generations Wellness currently offers HBOT on a self-pay basis while it works toward insurance contracts. We do not bill commercial insurance, Medicare or Medi-Cal at this time. For patients who meet NCD 20.29 criteria and depend on coverage, a facility that bills their plan may be more appropriate financially, and we will tell the patient that directly. For patients who choose self-pay, pricing is reviewed at the consultation; see self-pay pricing for your patients.

Codes and criteria, for reference

• CPT 99183: physician attendance and supervision of HBOT, per session
• HCPCS G0277: HBOT, full-body chamber, per 30-minute interval (a 90-minute session is 3 units); C1300 was discontinued January 1, 2015
• Medicare: 15 covered conditions under NCD 20.29, with wound reassessment at least every 30 days; see NCD 20.29 criteria
• Prior authorization: not required by Original Medicare when criteria are met; commonly required by commercial and Medicare Advantage plans; see prior authorization

Elements of a letter of medical necessity

Wherever the patient is treated, an effective letter typically states the diagnosis with ICD-10 code, the standard therapies tried and their duration, how each policy criterion is met (for example, Wagner grade and 30-day course), and the proposed protocol and session count.

Podiatry and wound care

Refer diabetic lower-extremity ulcers once they are Wagner grade 3 or higher and have failed at least 30 days of adequate standard care. Send measurements, serial photos, the offloading and debridement history, and vascular studies. HBOT is an adjunct; your wound care continues. See diabetic foot ulcer.

Radiation oncology

Delayed soft-tissue and bony radiation injury is a recognized indication. RICH-ART (Oscarsson 2019), a randomized phase 2–3 trial at five Nordic centers without sham control, reported greater improvement in urinary symptom scores with HBOT for radiation cystitis compared with standard care. Send the treatment summary with site, dose and completion date.

Urology

For radiation cystitis, send cystoscopy findings, transfusion or hematuria history, and prior interventions. Typical courses are 30–40 treatments.

Oral surgery and dentistry

For established osteoradionecrosis, refer with imaging and radiation history. For extractions in an irradiated jaw, call early: the Marx protocol begins 20 sessions before the procedure, and the evidence for prophylaxis is mixed.

Plastic and reconstructive surgery

Compromised flaps and grafts are time-sensitive. Call rather than email, and send the operative note and current photos. See compromised grafts and flaps.

Otolaryngology

The AAO-HNS 2019 guideline states clinicians may offer HBOT combined with steroids within 2 weeks of onset of sudden sensorineural hearing loss, or as salvage within 1 month. Call promptly and send the audiogram. See sudden hearing loss.

Infectious disease and orthopedics

Chronic refractory osteomyelitis is evaluated as an adjunct to debridement and culture-directed antibiotics. No randomized trials exist; a UHMS review supports adjunctive use. Send cultures, imaging and the antibiotic plan. See chronic refractory osteomyelitis.