How Many Hyperbaric Oxygen Therapy Sessions Do You Need?

How many hyperbaric treatments you need depends almost entirely on your condition. There’s no single answer that applies to everyone.

Emergency conditions like carbon monoxide poisoning may require just one to three sessions. Chronic conditions like radiation injury to bone can require 60 or more. Most wound healing patients fall somewhere in between.

Here’s what determines the length of your treatment course.

Sessions by Condition

Session counts below reflect standard clinical protocols. Your hyperbaric physician may adjust based on your individual response to treatment.

Carbon monoxide poisoning: 1-3 sessions. This is an emergency condition treated acutely. Most patients complete treatment within 24 hours.

Decompression sickness: 1 to 15 or more sessions, depending on severity. Mild cases may resolve in 1-2 sessions. Severe Type II decompression sickness (affecting the spinal cord or brain) may require repeated treatment tables over several days.

Diabetic foot ulcers and non-healing wounds: 20-40 sessions. This is the most common use case for outpatient HBOT. Sessions run 5 days a week. A 40-session course takes about 8 weeks.

Osteoradionecrosis (ORN) and soft tissue radionecrosis: 20-60 sessions. The Marx protocol for ORN surgery involves 20 sessions before the operation and 10 sessions after, for a minimum of 30. More severe cases or those requiring additional surgeries may exceed 60 sessions.

Thermal burns: 15-30 sessions. Burns are often treated twice daily early in the course, then tapered to once daily.

Compromised skin grafts and flaps: 20-30 sessions, depending on graft response.

Chronic refractory osteomyelitis: 40-60 sessions in combination with surgical debridement and antibiotics.

Off-label uses (if pursued as self-pay): Session counts range from 20-80 depending on the condition and the protocol used. These aren’t standardized by any major medical body.

How Often Are Sessions Scheduled?

For most outpatient conditions, sessions run Monday through Friday, once per day. Weekends are typically off.

Acute and emergency conditions are different. Carbon monoxide poisoning, gas gangrene, and decompression sickness may require two to three sessions within a 24-hour period, or treatment every day including weekends, until the acute phase resolves.

Burns are often treated twice daily during the early acute phase, then tapered to once daily as healing progresses.

Twice-daily sessions are called “BID” (bis in die) protocols. They’re used when faster oxygen delivery is clinically necessary.

How Long Does a Full Course Take?

Here’s a rough timeline by condition at the standard 5-days-per-week schedule:

20-session course: 4 weeks
30-session course: 6 weeks
40-session course: 8 weeks
60-session course: 12 weeks

Missing sessions lengthens your course. It also interrupts the cumulative effect that makes HBOT work. Consistency matters, especially for wound healing.

For self-pay patients, knowing the course length upfront also helps with cost planning. A 40-session course at a standalone clinic charging $200 per session is an $8,000 commitment over two months. Read our How Much Does HBOT Cost? guide for a full cost breakdown.

How Is Progress Evaluated?

Your hyperbaric team doesn’t just count sessions and call it done. They measure how you’re responding throughout treatment.

For wound patients, progress is measured at regular intervals using wound size (length, width, depth), wound photographs, and transcutaneous oxygen pressure (TcPO2) testing. TcPO2 measures oxygen levels in the tissue around the wound. It’s one of the strongest predictors of whether HBOT will work for you.

The 30-session evaluation point is a common checkpoint. If a wound patient hasn’t shown measurable improvement by 30 sessions, continuing HBOT is unlikely to be beneficial. A good hyperbaric physician will make that call and stop treatment if it isn’t working.

For other conditions, progress is measured by symptom assessment, imaging, or clinical evaluation, depending on the diagnosis.

Insurance implications: Medicare and commercial insurers require ongoing documentation of medical necessity. If your wound isn’t progressing, coverage may not continue. Prior authorization may need renewal for long courses. Your facility’s billing team handles this, but it’s good to understand how it works. For more on coverage, read our Does Insurance Cover HBOT? guide.

A full overview of the conditions HBOT treats and why it helps is available on our Conditions Treated with HBOT page.

Frequently Asked Questions

How many sessions does insurance cover?

Insurance covers medically necessary sessions for FDA-approved indications. There’s no fixed cap, but prior authorization must document ongoing medical necessity. If your wound isn’t responding to treatment, coverage may not continue beyond that point.

Can I do more sessions than recommended?

More isn’t always better. HBOT has diminishing returns, and risks like pulmonary oxygen toxicity increase with very high cumulative doses. A hyperbaric physician determines when you’ve received enough. Don’t pursue additional sessions outside of physician supervision.

What if I don’t finish all my sessions?

For wound healing, completing your full recommended course matters. Stopping early is better than never starting, but you may not get the full benefit. If you need to pause treatment, talk to your provider. They can advise on whether restarting makes sense.

Is every-other-day HBOT less effective?

Daily sessions five times per week are the standard protocol. Some patients do every other day due to scheduling constraints. The evidence is strongest for daily protocols. Ask your hyperbaric physician what’s right for your specific condition and situation.

Medical Disclaimer: This page is for informational purposes only. It does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before pursuing any medical treatment.