Cost & Insurance
Does Medicare Cover Hyperbaric Oxygen Therapy?
Yes, for 15 conditions listed in Medicare's National Coverage Determination 20.29, when the documentation criteria are met. You then generally owe the Part B deductible and 20% coinsurance. Other uses are not covered. Generations Wellness does not bill Medicare today, and we'll explain your options honestly.
NCD 20.29
Medicare Hyperbaric Oxygen Therapy Covered Conditions
Medicare's rules for hyperbaric oxygen therapy (HBOT) are set out in National Coverage Determination (NCD) 20.29, version 4, effective April 3, 2017. It lists 15 conditions. Medicare Part B may cover HBOT for these conditions when the medical records show the criteria are met. This summary is current as of September 2026.
- Acute carbon monoxide intoxication
- Decompression illness
- Gas embolism
- Gas gangrene
- Acute traumatic peripheral ischemia
- Crush injuries and suturing of severed limbs
- Progressive necrotizing infections (necrotizing fasciitis)
- Acute peripheral arterial insufficiency
- Preparation and preservation of compromised skin grafts (not for primary management of wounds)
- Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management
- Osteoradionecrosis, as an adjunct to conventional treatment
- Soft-tissue radionecrosis, as an adjunct to conventional treatment
- Cyanide poisoning
- Actinomycosis, only as an adjunct to conventional therapy when the disease is refractory to antibiotics and surgery
- Diabetic wounds of the lower extremities, in patients who meet three criteria (below)
Several of these are emergencies treated in hospital-based chambers. For outpatient care, the most common ones are diabetic foot wounds, osteoradionecrosis and soft-tissue radiation injury, compromised skin grafts and flaps, and chronic refractory osteomyelitis.
Diabetic foot ulcers: the three criteria
For a diabetic wound, Medicare requires all three of these:
- You have type 1 or type 2 diabetes and a lower-extremity wound caused by diabetes.
- The wound is Wagner grade 3 or higher.
- You have had an adequate course of standard wound therapy, and the wound has shown no measurable signs of healing for at least 30 days.
| Wagner grade | What it means |
|---|---|
| Grade 0 | Skin intact; a pre-ulcer area |
| Grade 1 | Superficial ulcer |
| Grade 2 | Deeper ulcer reaching tendon, joint capsule or deep tissue, without abscess or bone infection |
| Grade 3 | Deep ulcer with abscess, osteomyelitis (bone infection) or joint infection |
| Grade 4 | Gangrene in part of the foot |
| Grade 5 | Gangrene of the whole foot |
Standard wound care usually means cleaning and debriding the wound, treating infection, taking pressure off the foot, and checking blood flow. Read more about HBOT for diabetic foot ulcers.
The 30-day reassessment rule
Coverage does not continue automatically. During HBOT, the wound must be evaluated at least every 30 days. If there is no measurable sign of healing in any 30-day period, Medicare stops covering further HBOT. That is why physicians measure and photograph wounds on a regular schedule. The records show whether the wound is responding, and they guide whether the plan should change.
Outside the List
What Medicare Does Not Cover
NCD 20.29 also names 22 conditions where Medicare does not cover HBOT. Examples include:
- Cutaneous, decubitus (pressure) and stasis ulcers
- Thermal burns
- Pulmonary emphysema
- Exceptional blood-loss anemia
- Multiple sclerosis
- Senility
- Myocardial infarction
The general rule is simple. If a condition is not on the covered list, Medicare treats HBOT for it as not covered. Sessions for other uses are self-pay in any setting. To learn what studies say about uses that are not cleared, see our HBOT research summaries.
2026 Costs
What You'll Pay With Original Medicare
When HBOT is covered under Part B at a facility that bills Medicare, you typically pay:
- The Part B deductible: $283 in 2026, once per year.
- 20% coinsurance after the deductible. For hospital outpatient services, the coinsurance for a single service is capped at the Part A deductible, which is $1,736 in 2026.
Published estimates put the patient's share at roughly $90 to $115 per session after the deductible. A Medigap (Medicare Supplement) plan may pay some or all of that 20%.
| Sessions | At $90 per session | At $115 per session |
|---|---|---|
| 20 sessions | $1,800 | $2,300 |
| 30 sessions | $2,700 | $3,450 |
| 40 sessions | $3,600 | $4,600 |
Add any part of the $283 deductible you have not already met this year. If you have Medigap or other secondary coverage, your share may be lower. For comparison, see self-pay HBOT pricing.
Part C
Does Medicare Advantage Cover HBOT?
Medicare Advantage plans must cover at least what Original Medicare covers, so the 15 NCD 20.29 conditions still apply. What changes is how you get there:
- Networks. Many plans only pay for care at in-network facilities.
- Copays. You may pay a flat copay per session instead of 20% coinsurance.
- Prior authorization. Most Advantage plans require approval before HBOT starts.
Call the member services number on your card and ask for the plan's HBOT policy, its prior-authorization steps, and which facilities near you are in network. For other plan types, see other insurance plans.
For Doctors' Offices
Codes and Documentation Your Doctor's Office Will Use
You don't need to know billing codes, but they can help when you talk to Medicare or a billing office.
- CPT 99183 covers physician attendance and supervision, billed per session.
- HCPCS G0277 covers the facility's full-body chamber time, billed per 30-minute interval. A 90-minute session is 3 units.
- C1300 is an older facility code that was discontinued on January 1, 2015.
Documentation Medicare expects
The records need to support every criterion. For a diabetic foot wound, that usually includes:
- The diabetes diagnosis and the wound diagnosis, coded in ICD-10
- Wound location, measurements and photos
- The Wagner grade
- At least 30 days of standard wound care, with notes showing no measurable healing
- A physician's order and treatment plan
- Progress notes at least every 30 days during HBOT
Referring offices can find a fuller documentation checklist for referring offices.
Approval
Does Medicare Require Prior Authorization for HBOT?
Original Medicare does not require prior authorization for HBOT when the NCD 20.29 criteria are met. CMS did run a prior-authorization model for non-emergency HBOT in the past, but it was a limited demonstration, not the standard rule. Even without prior approval, Medicare can review the records later, so documentation still matters.
Medicare Advantage is different. Most Advantage plans do require prior authorization for HBOT.
At Generations Wellness
Medicare and Generations Wellness Today
Here is the honest picture. Generations Wellness currently offers HBOT on a self-pay basis while we work toward insurance contracts. We do not bill Medicare, Medicare Advantage or Medi-Cal today. That means Medicare will not pay toward sessions at our center right now, even if your condition is on the covered list.
If you may meet the NCD 20.29 criteria, that matters for your budget. A facility that bills Medicare could cost you much less out of pocket. We will tell you that plainly. To understand the trade-offs between settings, read about hospital-based vs. independent HBOT.
If your condition isn't covered, or you choose to self-pay, Dr. Rajwinder Singh Bahia, MD, directs care at our center, starting with a physician assessment. Pricing for your plan is reviewed with you clearly before you commit. Ask us about your situation at (369) 222-0979, and we'll explain your options honestly.
Important
A physician assessment is required before beginning HBOT at Generations Wellness. HBOT complements, and never replaces, the treatment prescribed by your doctors.
Questions
Medicare and HBOT: Frequently Asked Questions
Does Medicare cover hyperbaric oxygen therapy?
Yes, for 15 conditions listed in NCD 20.29 when the documentation criteria are met. Other uses are not covered.
What is a Wagner grade 3 diabetic ulcer?
A deep ulcer with an abscess, osteomyelitis (bone infection) or joint infection. It is the minimum severity Medicare requires for HBOT coverage of a diabetic wound.
How much does HBOT cost with Medicare?
After the $283 Part B deductible (2026), you generally owe 20% coinsurance. Published estimates are roughly $90 to $115 per session, and Medigap may reduce that.
Does Medicare Advantage cover HBOT?
It must cover what Original Medicare covers, but with its own network, copays and prior-authorization steps.
What happens if my wound isn't improving?
Medicare requires reassessment at least every 30 days. If there is no measurable healing in a 30-day period, coverage for more HBOT ends, and your physician revisits the plan.
Can I use Medicare at Generations Wellness?
Not at this time. We are self-pay today and do not bill Medicare. Call us and we'll explain your options honestly, including when another setting may make more financial sense.
Sources
- Centers for Medicare & Medicaid Services. National Coverage Determination 20.29, Hyperbaric Oxygen Therapy (Version 4). cms.gov
- HFMA. CY 2026 OPPS/ASC Final Rule Summary (Part B deductible and coinsurance). hfma.org
- Medicare.gov. Medicare costs. medicare.gov
- Hyperbaric Finder. Hyperbaric Oxygen Therapy Cost 2026. hyperbaricfinder.com
- Noridian Healthcare Solutions. Hyperbaric Oxygen (HBO) Therapy billing guidance. noridianmedicare.com
- Centers for Medicare & Medicaid Services. Prior Authorization Model for Non-Emergent Hyperbaric Oxygen Therapy, FAQ. cms.gov
- Wound Care Education Institute. The Wagner Scale. wcei.net
This page is educational and not medical advice. Medicare details reflect NCD 20.29 and 2026 cost-sharing as of September 2026; dollar figures are general ranges, not quotes. 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