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Is Hyperbaric Oxygen Therapy Covered by Insurance?

Hyperbaric oxygen therapy (HBOT) has been used for several decades and has been approved by the FDA to treat many health conditions. The treatment involves breathing in concentrated oxygen under increased pressure and is commonly used to treat wounds, burns, infections, and other injuries. Due to its broad medical use, it's important to understand health insurance coverage of this treatment.

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What is hyperbaric oxygen therapy?

In hyperbaric oxygen therapy, a person receives 100% oxygen delivered within a pressurized chamber. The amount of oxygen received is much more significant than the average amount a person would typically breathe in room air. Receiving such a concentrated amount of oxygen allows lungs and tissues to receive more oxygen, and this promotes wound healing, increases tissue perfusion, and kills certain types of bacteria.

Sessions can range from minutes to hours, depending on your treatment needs, and this treatment is provided at several hospitals and clinics across the United States. Currently, the FDA has approved HBOT for treating 14 different conditions. HBOT is also sometimes used off-label to treat additional conditions.

You should only receive HBOT while under the supervision of a medical provider, and you should receive treatment at an approved facility.

Does insurance pay for hyperbaric oxygen therapy?

Many private health insurance and employer plans cover hyperbaric oxygen therapy. However, coverage can vary greatly among plans. Some of the best health insurance plans of 2024, Kaiser Permanente, Cigna, and Aetna, provide coverage for HBOT. Each plan considers therapy a medical necessity. However, the specific conditions covered vary across plans. Things to consider when reviewing your plan include:

  • Number of sessions. Be sure to understand the number of sessions your insurance will cover. For instance, you may be limited to 10 sessions to treat carbon monoxide poisoning.
  • Length of session. You should review the number of minutes or hours you are allowed to receive treatment per session. You may only be allowed 60 minutes per session.
  • Off-label use. If your illness is not an FDA-approved indication for HBOT, you may have to submit additional paperwork to prove medical necessity. Furthermore, your insurance company may not cover the treatment.

It is essential to know that even though the therapy is covered, you may still be required to obtain prior authorization before starting treatment. Prior authorization is a mechanism insurance companies use to manage their costs for covered services. If you require prior authorization, your provider can submit paperwork justifying treatment on your behalf to your insurance company. Reviewing your health plan for more information is essential to determine if prior authorization approval will be needed.

Does medicare cover hyperbaric oxygen therapy?

Hyperbaric oxygen chambers are considered medical devices. Therefore, this service is covered under Medicare Part B. Medicare will cover the cost of hyperbaric oxygen therapy if it is used to treat conditions such as:

  • Carbon monoxide and cyanide poisoning
  • Gas embolism
  • Gas gangrene
  • Diving sickness
  • Injury due to radiation or crush
  • Necrotizing infections and refractory bone infections
  • Diabetic wound treatment under certain conditions
  • Skin grafts at risk of failure
  • Actinomycosis, after surgery and antibiotic failure
  • Acute peripheral ischemia or arterial insufficiency

Your out-of-pocket cost will be 20% of the Medicare-approved cost. Additionally, you may have to pay your Part B deductible as well.

How to appeal an insurance denial for hyperbaric oxygen therapy

Your insurance plan may only cover the cost of your HBOT initially if the company feels you meet the appropriate criteria. You have the right to file an appeal if your insurance claim is denied. You can start the appeal by writing a letter to your insurance company explaining why you've chosen this therapy and why this therapy is essential for your health.

You should include in the letter information regarding other treatments that you have tried, but those therapies have yet to successfully treat your issue. Be sure to include documentation from your provider about why this therapy is medically necessary in your appeal. Your provider may also have to write a letter explaining the importance of this treatment. It is essential to carefully review your insurance policy to learn more about the specifics of their appeal process.

Finding affordable hyperbaric oxygen therapy

If you do not have insurance to assist with the cost of HBOT, you may consider the alternatives listed below.

  • Explore financial assistance programs. There may be centers or clinics near you that offer financial assistance programs or discounts if you meet specific criteria. Try searching an online medical directory to find providers in your area. Contact the facilities to learn more about your options.
  • Research clinical trials. There may be clinical trials happening in your area evaluating HBOT therapy for various conditions. The therapy may be provided at no charge or at a reduced cost. If you meet the enrollment criteria, you may want to consider joining a clinical trial to receive your treatment.

Hyperbaric oxygen therapy is an effective treatment option for increasing oxygen in the blood and tissues. Often, several treatments are needed, so be sure to verify your coverage options with your insurance company before you begin treatment. Some risks associated with HBOT include potential ear pain and injury, as well as visual changes. Discuss your treatment options and goals of therapy with your provider to determine if hyperbaric oxygen therapy is right for you.


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