Does Insurance Cover Hyperbaric Oxygen Therapy?

Insurance does not cover hyperbaric oxygen therapy (HBOT) as a general service. It may cover HBOT for a short list of specific conditions, and only when your medical records show you meet the plan's criteria. The diagnosis matters more than the plan.

Most commercial plans, Medicare Advantage plans and Medi-Cal use rules that closely follow Medicare's list, called National Coverage Determination (NCD) 20.29. That list overlaps with the conditions the FDA has cleared hyperbaric chambers to treat. You can read about each one on our page on the FDA-cleared indications.

These notes describe how coverage generally works. They are not coverage promises. Always confirm with your plan, using the member services number on your card.

Original Medicare

Medicare Part B may cover HBOT for the 15 conditions listed in NCD 20.29 when the documentation criteria are met. Wounds must be reassessed at least every 30 days. For the full list, the costs and the 30-day rule, read Medicare's HBOT coverage rules.

Medicare Advantage

Medicare Advantage (Part C) plans must cover at least what Original Medicare covers. Their network, copay and prior-authorization rules can differ, so ask your plan for its HBOT policy and whether a given facility is in its network.

Medi-Cal

Medi-Cal can cover medically necessary HBOT for recognized conditions, with a Treatment Authorization Request (TAR) approved in advance. Medi-Cal managed care plans apply the same medical-necessity standard through their own authorization steps.

Kaiser Permanente

Kaiser publishes clinical review criteria for HBOT. Kaiser members are generally treated within Kaiser or at a facility Kaiser refers them to. Treatment outside Kaiser without its authorization is usually self-pay.

Anthem Blue Cross, Blue Shield of California, Aetna and UnitedHealthcare

Each publishes its own HBOT medical policy. The covered lists largely follow the conditions recognized by Medicare and the Undersea and Hyperbaric Medical Society (UHMS), and prior authorization is common.

TRICARE and the VA

TRICARE and the VA cover HBOT for recognized conditions under their own rules. VA community care requires authorization from the VA before care outside the VA begins.

For a closer look at each California plan's published policy, read our guide to Medi-Cal, Kaiser and Blue Shield details.

A denial is not always the final word. First, read the written reason. Denials usually fall into one of two groups:

• "Not a covered condition." The diagnosis is not on the plan's list. Appeals rarely change this, because the policy itself excludes it.
• "Not enough documentation." Something is missing, such as the Wagner grade, proof of 30 days of standard care, or wound photos. This kind of denial can often be fixed.

How appeals usually work

Your physician can ask for a peer-to-peer review, where they talk directly with the plan's medical reviewer. A letter of medical necessity explains the diagnosis, the treatments already tried, how each criterion is met, and the planned course. Referring offices can find more on documentation in our page on letters of medical necessity and referral. California members of many commercial plans can also ask the state's Department of Managed Health Care for an Independent Medical Review after the plan's own appeal.

Paying for HBOT yourself

When a condition isn't covered, HBOT is self-pay everywhere. Health savings and flexible spending accounts (HSA and FSA) are generally eligible when HBOT is prescribed by a physician for a medical condition. Confirm with your plan administrator before you start.