Medicare Coverage for HBOT: Condition-by-Condition Breakdown

Medicare’s HBOT coverage is more specific than most patients realize. It’s not enough to have a condition that HBOT has been studied for. Your condition must match one of the 14 indications in National Coverage Determination (NCD) 20.29, your wound or diagnosis must meet documented clinical criteria, and treatment must happen at a hospital outpatient department.

This page breaks down every covered condition and what you need to qualify.

The 14 Medicare-Covered HBOT Indications

Acute Carbon Monoxide Intoxication

Medicare covers HBOT for CO poisoning. There are no published Wagner-style severity criteria in NCD 20.29 for CO — the clinical decision of when to use HBOT versus normobaric O2 is left to physician judgment based on symptom severity. Loss of consciousness, neurological symptoms, and cardiac involvement typically indicate HBOT. See our carbon monoxide poisoning page.

Decompression Illness (DCS)

HBOT is the primary treatment for decompression sickness in divers. Symptoms after ascending too quickly — joint pain, neurological symptoms, skin mottling — indicate recompression treatment. Coverage is based on documented DCS diagnosis. See decompression sickness.

Arterial Gas Embolism

Gas bubbles entering the arterial circulation, typically from pulmonary barotrauma during ascent, require emergency HBOT. Covered under NCD 20.29.

Gas Gangrene (Clostridial Myonecrosis)

Clostridial gas gangrene is a life-threatening anaerobic infection. HBOT is adjunctive to surgical debridement and antibiotics. Covered as an adjunct.

Acute Traumatic Peripheral Ischemia

Limb-threatening ischemia following trauma — crush injuries, compartment syndrome risk — where vascular reconstruction is pending or incomplete. Covered as adjunct.

Crush Injuries and Suturing of Severed Limbs

Traumatic amputations and severe crush injuries where HBOT supports tissue viability during and after surgical repair. Covered as adjunct.

Progressive Necrotizing Infections

Necrotizing fasciitis and other rapidly spreading soft tissue infections. HBOT is adjunctive to surgery and antibiotics for infections not involving gas-forming organisms.

Acute Peripheral Arterial Insufficiency

Acute arterial occlusion causing limb ischemia. Covered as adjunct when surgical or interventional options are limited.

Compromised Skin Grafts and Flaps

Skin grafts or surgical flaps showing signs of failure or at high risk of failure. This is the medical indication (not cosmetic). Coverage requires documentation of graft compromise. See skin grafts and flaps.

Chronic Refractory Osteomyelitis

Bone infection that hasn’t responded to standard antibiotic and surgical treatment. “Refractory” means documented failure of conventional treatment. Coverage requires documented treatment history.

Osteoradionecrosis

Radiation-damaged bone (most commonly mandible after head and neck radiation therapy) that doesn’t heal. Covered as adjunct to conventional treatment.

Soft Tissue Radionecrosis

Radiation-damaged soft tissue that doesn’t heal. Covered as adjunct. See radiation injury.

Cyanide Poisoning

Similar to CO poisoning — covered for acute poisoning with tissue oxygen delivery disruption.

Actinomycosis

A bacterial infection caused by Actinomyces species. Covered as adjunct to conventional therapy.

The Most Specific Criteria: Diabetic Wounds

Diabetic wounds of the lower extremities have the most detailed coverage criteria in NCD 20.29. All four of the following must be documented:

1. The patient has Type I or Type II diabetes
2. The wound is located on the lower extremity (foot or leg)
3. The wound is diabetic in etiology (caused by diabetic neuropathy, vascular disease, or both)
4. The wound is Wagner Grade III or higher

Wagner Grade III means full-thickness wound involving tendon, capsule, or bone — not just skin and subcutaneous tissue. Grades I and II don’t qualify. A superficial diabetic ulcer, even if not healing, won’t meet Medicare criteria.

Additionally:

• The patient must have had 30 days of standard wound care before HBOT — and that care must be documented as provided by a healthcare professional, not self-care.
• Standard wound care must have failed to produce measurable improvement.

These criteria mean patients with new or mild wounds typically need to work through wound care first. HBOT under Medicare is a second-line intervention for the most severe diabetic wounds.

Facility Requirement

This one surprises many patients: Medicare requires HBOT to be delivered at a hospital outpatient department. That means:

Standalone HBOT clinics: not eligible for Medicare billing, even if they treat a covered condition. Wellness centers and spas: not eligible. Private hyperbaric facilities not affiliated with a hospital: not eligible.

If you want Medicare to pay, the HBOT must happen at a hospital’s outpatient hyperbaric program. Many hospitals with hyperbaric programs are connected to wound care centers. Find one through the UHMS directory at uhms.org or ask your physician for a referral to a hospital-based program.

What Medicare Pays

Medicare’s approved reimbursement amount changes annually. Historically, the approved amount per session has been in the range of $150 to $300. Your 20% coinsurance after Medicare pays its 80% share is typically $30 to $60 per session.

Do not treat these figures as current. Verify the actual rates with your facility’s billing team before starting treatment. Medigap/supplement policies may cover the 20% coinsurance — check your plan.

For more on insurance generally, see our HBOT insurance guide. For Medicaid, see Medicaid HBOT coverage.

What Medicare Won’t Cover

Medicare will not cover HBOT for any of the following, regardless of physician order:

TBI, concussion, post-concussion syndrome, chronic traumatic encephalopathy, Long COVID, long-haul COVID symptoms, PTSD, autism spectrum disorder, Alzheimer’s disease, Parkinson’s disease, Lyme disease, fibromyalgia, chronic fatigue syndrome, anti-aging, athletic recovery, or any other investigational/off-label use.

If a provider tells you Medicare will cover HBOT for any of these conditions, that’s incorrect. Get the coverage determination in writing before starting treatment.

FAQ

Do I need a referral to start Medicare-covered HBOT? You need a physician order. The treating hyperbaric physician may also need to be on your care team. The facility’s billing team can walk you through the referral process.

What if my wound improves to Wagner Grade II during treatment? Medicare coverage is based on entry criteria. If your wound improves significantly, your physician and the facility should reassess whether continued HBOT is medically necessary and covered. Coverage may not continue indefinitely if healing is documented.

Does Medicare Advantage cover HBOT? Medicare Advantage plans must cover what traditional Medicare covers, but they may have additional requirements — different networks, different prior authorization processes, different facility requirements. Verify with your specific Advantage plan before starting treatment.

Can I appeal a Medicare denial for HBOT? Yes. Medicare denials can be appealed through the standard Medicare appeals process. Your denial notice will include appeal instructions. Successful appeals typically require additional clinical documentation showing the condition meets NCD 20.29 criteria.

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. Medicare coverage determinations depend on your specific diagnosis, documentation, and facility. Always verify coverage with your Medicare plan and get prior authorization before treatment. Reimbursement rates change annually — verify current rates with your facility’s billing team.