Does Insurance Cover Hyperbaric Oxygen Therapy?

The short answer is yes, for FDA-approved conditions with proper documentation. No, for off-label uses.

If your doctor prescribed HBOT for a covered condition like a diabetic foot wound or radiation injury, your insurer may cover most of it after prior authorization. If you’re pursuing HBOT for TBI, Long COVID, or anti-aging, you’ll pay out of pocket.

Read this before your first session.

Which Conditions Does Insurance Cover?

Insurance covers HBOT for conditions that have FDA clearance and strong clinical evidence. Medicare maintains a list of 14 approved indications under National Coverage Determination (NCD) 20.29.

Covered conditions include:

Diabetic lower-extremity wounds (Wagner Grade III or higher)
Osteoradionecrosis (radiation damage to bone)
Soft tissue radionecrosis
Chronic refractory osteomyelitis
Compromised skin grafts and flaps
Arterial insufficiency ulcers
Acute traumatic ischemia
Crush injuries
Carbon monoxide poisoning
Decompression sickness
Gas embolism
Clostridial myonecrosis (gas gangrene)
Cyanide poisoning
Actinomycosis

Off-label conditions are a different story. TBI, concussion, autism, fibromyalgia, Lyme disease, Long COVID, and anti-aging uses aren’t recognized by Medicare or any commercial insurer in the U.S. These are considered investigational. You’ll pay the full cost yourself.

See our Conditions Treated with HBOT page for a full breakdown of what the evidence says for each condition.

Medicare Coverage Rules

Medicare Part B covers HBOT under NCD 20.29. There are specific requirements your treatment must meet.

Facility type matters. Medicare only covers HBOT performed at a hospital outpatient department. Standalone clinics and wellness centers don’t qualify, even if your condition is on the approved list.

Medical necessity must be documented. Your treating physician must provide a written order. Your chart must show the diagnosis, prior treatments attempted, and why HBOT is necessary.

For wound patients, Medicare requires evidence that standard wound care failed for at least 30 days before HBOT can be covered. Wound measurements, photos, and transcutaneous oxygen (TcPO2) testing results are typically required.

Your cost under Medicare is 20% coinsurance after your Part B deductible. The Medicare-approved amount per session has historically averaged $150-300, putting your 20% share in the $30-60 range per session. Medicare rates change annually, so confirm the current approved amount with your facility’s billing team before starting treatment.

For more on what you’ll actually pay, read our How Much Does HBOT Cost? guide.

Commercial Insurance Coverage

Major commercial insurers, including Blue Cross Blue Shield, Aetna, Cigna, and UnitedHealthcare, generally follow Medicare’s coverage criteria. If Medicare covers your condition, your commercial plan likely will too.

That said, prior authorization is almost always required before you start treatment. Don’t assume you’re covered. Get the approval in writing first.

Some commercial plans have additional restrictions. They may limit the number of sessions covered, require specific diagnostic codes, or impose waiting periods. Call your insurer before your first session and ask specifically about HBOT coverage for your diagnosis.

Your hyperbaric facility’s billing team deals with this every day. Let them lead the prior authorization process.

Medicaid coverage varies by state. Some states cover the same indications as Medicare. Others restrict coverage further or exclude HBOT entirely. Contact your state Medicaid office or the facility’s billing team to check your specific plan.

What You’ll Need to Get Approved

Insurance companies don’t approve HBOT automatically. You’ll need documentation. Here’s what’s typically required:

Physician order or prescription signed by your treating physician
ICD-10 diagnosis code matching a covered indication
Records of prior treatment failure (for wounds, at least 30 days of standard wound care with no improvement)
Wound measurements and photographs (for wound patients)
TcPO2 testing results showing tissue oxygen levels for wound patients
Treatment notes from your referring physician

Hospital-based wound care centers handle this routinely. If you’re being treated at a hospital outpatient program, their staff will gather and submit all required documentation. You shouldn’t have to do this yourself.

If your claim is denied, you have the right to appeal. Your physician can write a letter of medical necessity. The facility’s billing team knows the appeals process and can guide you through it.

Frequently Asked Questions

Does Medicare cover HBOT for diabetic foot wounds?

Yes. Medicare covers HBOT for diabetic lower-extremity wounds classified as Wagner Grade III or higher that haven’t healed after 30 days of standard wound care. Treatment must be performed at a hospital outpatient facility.

Does insurance cover HBOT for TBI or concussion?

No. TBI and concussion are off-label uses. Medicare and commercial insurers don’t cover them. Patients pay out of pocket for these treatments. There’s no U.S. insurance plan that covers HBOT for TBI at this time.

How do I get insurance approval for HBOT?

Your treating physician writes an order. The hyperbaric facility submits prior authorization to your insurer with supporting documentation. If you’re going to a hospital-based wound care center, their billing team handles this routinely. Start the process before your first session.

What if my insurer denies the claim?

You have the right to appeal. Ask your physician to write a letter of medical necessity. The hyperbaric facility’s billing department deals with denials regularly and can walk you through the process. Don’t give up after a first denial.

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.