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Conditions of Coverage
Hyperbaric oxygen therapy is a modality in which the entire body is
exposed to oxygen under increased atmospheric pressure. Effective April
1, 2003, a National Coverage Decision expanded the use of Hyperbaric
Oxygen (HBO) therapy to include coverage for the treatment of diabetic
wounds of the lower extremities in patients who meet the following
criteria:
(1) Patient has type I or type II diabetes and has a lower extremity
wound that is due to diabetes; (ICD-9-CM diagnosis 250.7, 250.8, 707,
707.1, 707.10, 707.12, 707.13, 707.14, and 707.19).
(2) Patient has a wound classified as Wagner grade III or higher; and
(3) Patient has failed an adequate course of standard wound therapy.
The use of HBO therapy will be covered as adjunctive therapy only after
there are no measurable signs of healing for at least 30 days of
treatment with standard wound therapy and must be used in addition to
standard wound care. Standard wound care in patients with diabetic
wounds includes: assessment of a patient's vascular status and
correction of any vascular problems in the affected limb if possible,
optimization of nutritional status, optimization of glucose control,
debridement by any means to remove devitalized tissue, maintenance of
clean, moist bed of granulation tissue with appropriate moist
dressings, appropriate off-loading, and necessary treatment to resolve
any infection that might be present. Failure to respond to standard
wound care occurs when there are no measurable signs of healing for at
least 30 consecutive days. Wounds must be evaluated at least every 30
days during administration of HBO therapy. Continued treatment with HBO
treatment is not covered if measurable signs of healing have not been
demonstrated within any 30-day period of treatment.
This PM also clarifies that CMS has concluded that special supervision
and credentialing requirements should not be imposed on physicians who
perform HBO therapy. You may not impose a higher level of supervision
than direct supervision as is required for all "incident to" therapies.
CMS encourages physicians who perform HBO therapy to obtain adequate
training in the use of HBO therapy and in advanced cardiac life
support.
NOTE: Topical application of oxygen does not meet the definition of HBO
therapy as stated above. Also, its clinical efficacy had not been
established. Therefore, no Medicare reimbursement may be made for the
topical
application of oxygen.
More to be presented during the didactic session!
Thanks.
