Does Medicaid Cover Hyperbaric Oxygen Therapy?

Medicaid coverage for HBOT exists — but it’s more complicated than Medicare because Medicaid is state-administered. The answer isn’t the same in every state or even in every managed care plan within a state.

How Medicaid Coverage Works

Medicare is a federal program with uniform coverage rules nationwide. Medicaid is a joint federal-state program where each state sets its own coverage policies within federal guidelines.

Most states model their Medicaid HBOT coverage on Medicare NCD 20.29, which covers 14 FDA-approved indications including diabetic wounds, radiation injury, osteomyelitis, CO poisoning, and decompression sickness. But “most states” isn’t all states, and within a state, Medicaid managed care organizations (MCOs) may have additional restrictions layered on top.

The practical result: you can’t assume Medicaid will cover HBOT in your state without verifying with your specific plan.

What’s Covered and What Isn’t

FDA-approved indications: generally covered in most states when criteria are met and prior authorization is obtained.

Off-label indications: not covered by any state Medicaid program. This includes TBI, Long COVID, autism, Parkinson’s, Alzheimer’s, PTSD, fibromyalgia, and anti-aging use. If a provider tells you Medicaid will cover HBOT for any of these purposes, that’s incorrect.

Home chambers: not covered under Medicaid anywhere.

How to Verify Your Coverage

Don’t call a general Medicaid helpline and ask whether “Medicaid covers HBOT.” You’ll get an incomplete answer. Instead:

Find out which managed care organization administers your Medicaid benefits. Your Medicaid card should show the MCO name.

Call the MCO directly. Ask: “Does your plan cover hyperbaric oxygen therapy for [your specific diagnosis and ICD-10 code]?”

Get specifics. Ask about prior authorization requirements, facility requirements (hospital outpatient vs. standalone clinic), and session limits.

Document everything. Write down the representative’s name, the date of the call, and ask for a reference number. Prior authorization denials and billing disputes are much easier to fight when you have a paper trail.

Prior Authorization Is Almost Always Required

Medicaid HBOT claims almost universally require prior authorization. Don’t start treatment without written approval. A verbal approval from a provider’s office isn’t enough — get the authorization number from the MCO directly.

Prior authorization for Medicaid HBOT typically requires:

• Physician order with diagnosis documented
• ICD-10 code matching an approved indication
• Documentation that standard treatment criteria have been met (e.g., 30 days of wound care for diabetic wounds)
• Facility enrolled as a Medicaid provider

Facility Enrollment Matters

HBOT facilities must be enrolled as Medicaid providers to bill for covered services. Some facilities — particularly standalone hyperbaric clinics and wellness centers — aren’t Medicaid-enrolled. Some that are enrolled for other services haven’t completed enrollment for HBOT billing specifically.

Call the facility before scheduling: “Are you an enrolled Medicaid provider for hyperbaric oxygen therapy? Do you accept [specific MCO name]?” This saves you from getting a bill after treatment that you expected Medicaid to cover.

Medicaid reimbursement rates for HBOT are lower than Medicare rates, which are already lower than commercial rates. Some facilities with hospital affiliations accept Medicaid. Standalone clinics sometimes don’t because the reimbursement doesn’t cover their costs. Ask directly.

Dual Eligibility: Medicare and Medicaid Together

If you’re enrolled in both Medicare (dual eligible), Medicare pays first for covered services. For HBOT covering an FDA-approved indication, Medicare covers 80% of the approved amount. Medicaid may cover the 20% coinsurance — but only depending on your state and specific plan.

Some dual-eligible beneficiaries are enrolled in Medicare Advantage plans, which have different coverage rules than traditional Medicare. If you have Medicare Advantage, verify with that plan’s authorization team separately.

See our general insurance and HBOT guide for the broader coverage picture, and our Medicare HBOT conditions page for the specific covered diagnoses.

Veterans and State Programs

A handful of states have passed legislation related to HBOT coverage for veterans through state Medicaid or dedicated state programs separate from federal Medicaid. If you’re a veteran, see our veterans HBOT guide for options beyond standard Medicaid, including VA coverage and state-specific programs.

FAQ

My doctor prescribed HBOT. Will Medicaid automatically cover it? A prescription alone doesn’t guarantee coverage. You need to verify coverage with your MCO, obtain prior authorization, and confirm the facility is Medicaid-enrolled before treatment starts.

Can I appeal a Medicaid HBOT denial? Yes. Medicaid coverage denials can be appealed. Your denial notice should include appeal instructions and deadlines. Appeals are often successful when the clinical documentation is complete and the indication clearly meets coverage criteria.

What if my state Medicaid doesn’t cover HBOT for my condition? For off-label conditions, no Medicaid pathway exists. Your options are out-of-pocket payment, clinical trials that may cover HBOT costs, or VA programs if you’re a veteran. See HBOT clinical trials for trial options.

Are Medicaid rates published somewhere? State Medicaid fee schedules are public records. Search “[your state] Medicaid fee schedule hyperbaric oxygen” or contact your state Medicaid office. Rates change annually.

Medical Disclaimer: The content on this page is for informational purposes only. It is not medical advice and does not create a doctor-patient relationship. Insurance coverage determinations depend on your specific plan, diagnosis, and documentation. Always verify coverage with your insurer and get prior authorization before treatment.