Does insurance cover hyperbaric oxygen therapy treatments?

Learn if hyperbaric treatments for your medical condition will be covered by insurance

 

One of the most common questions we hear from new patients is: “Is hyperbaric oxygen therapy covered by insurance?”

The short answer is yes. Hyperbaric oxygen therapy (HBOT) can be covered by Medicare and most commercial insurance plans, but coverage depends on your specific medical condition, your plan’s requirements, and whether your provider can document medical necessity.

Some insurance companies require prior authorization before they’ll cover HBOT, though Medicare does not require prior authorization if the condition meets coverage requirements. Your out-of-pocket cost will depend on your specific plan. Some patients pay only a copay, while others pay toward a deductible or coinsurance. With Medicare Part B, you typically pay 20% of the Medicare-approved amount after meeting your deductible, and in most instances, a Medicare supplement plan covers the remaining 20%. [1]

Continue reading as we break down which conditions are typically covered, which off-label conditions sometimes get approved, how to verify your benefits, and what your options are if your insurance denies coverage.

 

What conditions are commonly approved by insurance?

Medicare and most major commercial insurance carriers, including BlueCross BlueShield (BCBS), UnitedHealthcare, Cigna, Aetna, and Humana, will cover HBOT to treat the following conditions:

• Air or Gas Embolism
• Carbon Monoxide Poisoning
• Chronic Refractory Osteomyelitis
• Compartment Syndrome / Crush Injury / Other Acute Traumatic Ischemias*
• Compromised Skin Grafts and Flaps
• Decompression Sickness (the Bends)
• Diabetic Foot Wounds and Selected Problem Wounds
• Exceptional Blood Loss Anemia
• Gas Gangrene (Clostridial Myositis and Myonecrosis)
• Intracranial Abscess
• Necrotizing Soft Tissue Infections
• Osteoradionecrosis and Radiation Tissue Damage*
• Thermal Burns
• Actinomycosis (refractory to antibiotics and surgery)
• Arterial Insufficiency Ulcer
• Idiopathic Sudden Sensorineural Hearing Loss (covered by select commercial carriers)

*covered as adjunctive therapy 

 

Important coverage limitations

Several covered conditions come with strict requirements. For diabetic lower-extremity wounds, Medicare requires that the patient have Type 1 or Type 2 diabetes, that the wound has reached a serious stage (specifically a deep ulcer with infection reaching the bone, joint, or deeper tissue, classified as Wagner Grade III or higher on the standard diabetic ulcer severity scale), and that the patient has already failed an adequate course of standard wound therapy before HBOT can be authorized. [1]

In addition, many plans will only continue authorizing HBOT as adjunctive therapy when the wound is reassessed every 30 days and shows measurable signs of healing. If progress isn’t documented, coverage can be discontinued, even mid-treatment course.

 

Related resource:
How much does hyperbaric oxygen therapy cost?

 

Are there additional conditions sometimes covered by insurance?

Yes. Beyond the standard approved list, there are a number of off-label conditions that some commercial insurance carriers will cover when medical necessity can be clearly demonstrated through clinical documentation, prior treatment records, and physician letters of support. Off-label conditions that may be covered (case-by-case) include:

• Fibromyalgia
• Lyme Disease
• Migraine
• Multiple Sclerosis
• Near Drowning
• Post Traumatic Stress Disorder (PTSD)
• Recovery from Plastic Surgery
• Sports Injuries
• Stroke
• Traumatic Brain Injury
• Addiction
• Autism
• Anoxic Brain Injury
• Avascular Necrosis
• Cerebral Palsy
• Crohn’s Disease
• Circulation conditions
• Concussion
• Complex Regional Pain Syndrome

 

If you’re seeking HBOT for an off-label condition, expect insurers to request comprehensive medical records and a letter of medical necessity from your treating physician. Approval isn’t guaranteed, but it’s worth pursuing, and we help our patients build the strongest possible case.

 

What if my condition isn’t on the list?

You may still qualify for coverage. Most commercial insurance carriers will review medical records to determine medical necessity on a case-by-case basis.

At Hyperbaric Healing Treatment Center, we work directly with patients to build the strongest possible case for coverage by compiling medical records, drafting letters of medical necessity with your physician, submitting supporting research, managing the prior authorization process, and pursuing appeals when needed.

For patients whose insurance ultimately doesn’t cover treatment, we also offer discounted out-of-pocket packages. 

 

Does Medicare cover hyperbaric oxygen therapy?

Yes. Medicare Part B covers HBOT for FDA-approved conditions, including qualifying diabetic foot wounds, osteoradionecrosis, gas gangrene, and decompression sickness. You’ll typically pay 20% of the Medicare-approved amount after your Part B deductible.

Is HBOT covered by BCBS, UnitedHealthcare, or Cigna?

Most major carriers (BCBS, UnitedHealthcare, Cigna, Aetna, Humana) cover HBOT for standard approved conditions and sometimes approve off-label conditions when medical necessity is well-documented. Requirements vary by plan.

How many HBOT sessions will insurance cover?

Most Medicare and commercial insurance guidelines approve up to 20 treatments per month (once daily) for a total of up to 60 treatments per calendar year, for conditions that meet coverage criteria. Extensions beyond this may be possible if your provider documents clinical progress and ongoing medical necessity.

What if my insurance denies coverage?

You have the right to appeal. The process moves through redetermination, independent reconsideration, and (if necessary) an administrative law judge. We can help you build the documentation for your appeal, and self-pay packages are available if your appeal is unsuccessful.

Does insurance cover HBOT for off-label conditions like long COVID, TBI, or Lyme disease?

Sometimes. Commercial insurers occasionally approve these when supported by strong clinical documentation, but approval isn’t guaranteed.

Can I use HSA or FSA funds for HBOT?

Yes. HBOT is generally an eligible HSA/FSA expense when prescribed by a physician. Check with your plan administrator for documentation requirements.

 

We’re here to help you navigate coverage

Insurance for hyperbaric oxygen therapy can feel complicated, but you don’t have to figure it out alone. With locations in Orlando (Dr. Phillips), New Smyrna Beach, and Leesburg, our team has helped thousands of patients across Central Florida access the care they need.

 

Contact us today or call 407.530.0710 for an insurance benefits review.

 

1: Medicare | Does Medicare Cover Hyperbaric Oxygen Therapy?