TLDR

• Medicare Part B covers HBOT for 14 FDA-approved conditions, including diabetic foot wounds, radiation injuries, osteomyelitis, carbon monoxide poisoning, and more.
• You typically pay 20% of the Medicare-approved amount after your Part B deductible ($257 in 2025).
• Most major PPO plans (Blue Shield, Aetna, Cigna, UnitedHealthcare) also cover HBOT for the same conditions and sometimes additional diagnoses.
• Prior authorization is required for most non-emergency HBOT — documentation of the diagnosis and failed standard wound care is essential.
• OxygenWell in Sherman Oaks and Calabasas is a Medicare-approved, insurance-accepted facility. Their billing team handles all pre-authorizations.

Insurance questions are often the first thing patients ask when they learn about hyperbaric oxygen therapy. The short answer: yes, Medicare does cover HBOT — but only for specific FDA-approved conditions and only when strict documentation criteria are met. For PPO patients, coverage is also available and, in some cases, even more flexible.

This guide breaks down exactly what Medicare and PPO plans cover, what paperwork is required, and how OxygenWell's dedicated billing team handles the process so you can focus on healing.

Does Medicare Cover Hyperbaric Oxygen Therapy?

Medicare Part B (Medical Insurance) covers hyperbaric oxygen therapy when it is administered in an approved chamber — including a single-person (monoplace) unit — and you have a qualifying diagnosis. Coverage falls under the CMS National Coverage Determination (NCD) 20.29, which defines precisely which conditions qualify and what clinical criteria must be met.

Medicare does not cover HBOT delivered via a soft-sided portable chamber or topical oxygen application — only pressurized hard-sided chambers qualify.

The therapy must also be delivered at a facility that meets Medicare's safety and physician oversight standards. This is an important distinction: not every clinic advertising HBOT qualifies for Medicare reimbursement. OxygenWell is a physician-owned, Medicare-approved facility that meets all federal safety, oversight, and documentation requirements.

The Full List of Medicare-Covered HBOT Conditions

Medicare covers HBOT as a primary or adjunct treatment for the following 14 conditions:

ConditionKey Criteria Diabetic wounds of the lower extremitiesType 1 or 2 diabetes; Wagner Grade III or higher; failed standard wound care for at least 30 days Delayed radiation injuries (osteoradionecrosis, soft tissue radionecrosis, cystitis, proctitis)Post-radiation tissue damage confirmed by physician Chronic refractory osteomyelitisUnresponsive to standard antibiotic and surgical treatment Compromised skin grafts and flapsGraft or flap at risk of failure due to ischemia Acute traumatic peripheral ischemiaCrush injuries, reperfusion injury, compartment syndrome Gas gangrene (clostridial myonecrosis)Confirmed diagnosis, used alongside surgical debridement Progressive necrotizing infectionsFlesh-eating bacteria or necrotizing fasciitis Acute peripheral arterial insufficiencyArterial blood flow compromise to an extremity Air or gas embolismGas introduced into arterial or venous system Decompression sicknessDiving-related injury with confirmed symptoms Acute carbon monoxide poisoning / cyanide poisoningConfirmed toxic exposure Intracranial abscessBrain abscess adjunct therapy Exceptional blood loss anemiaWhen transfusion is refused or unavailable Central Retinal Artery Occlusion (CRAO)Time-sensitive; best results within first 24 hours

The most commonly treated Medicare-covered conditions at OxygenWell are diabetic foot wounds, radiation injuries (ORN, cystitis, proctitis), and osteomyelitis. These are also the conditions with the strongest evidence base and highest insurance approval rates.

What Documentation Does Medicare Require?

Documentation is the most critical factor in Medicare HBOT coverage. Medicare audits HBOT claims closely, and incomplete records are the primary reason claims get denied.

For diabetic wounds, documentation must include:

• A confirmed diagnosis of Type 1 or Type 2 diabetes
• Wound classification at Wagner Grade III or higher (supported by diagnostic testing)
• Evidence that standard wound care was provided for at least 30 consecutive days without measurable healing
• Wound assessment at the initial evaluation and every 30 days during HBOT
• Physician orders and a treatment plan signed by a qualified physician

For all covered conditions, the medical record must include:

• A complete history and physical examination
• Established diagnosis with medical necessity clearly stated
• Documentation of prior treatments tried and why they failed
• Physician orders and signatures for each treatment
• Treatment notes confirming the condition being treated

At OxygenWell, the treating physician conducts a thorough initial evaluation, establishes the clinical record, and works directly with a professional billing company to compile and submit all required documentation. Patients do not need to manage this paperwork themselves.

How Much Does Medicare Pay for HBOT?

Under Medicare Part B, the cost-sharing structure is straightforward:

• Medicare pays 80% of the Medicare-approved amount
• You pay the remaining 20%
• The Part B deductible ($257 in 2025) applies before coverage kicks in
• The estimated cost per HBOT session was approximately $595 in 2022, meaning your out-of-pocket share per session is roughly $119 after the deductible is met

If you have a Medicare Supplement (Medigap) plan, it may cover some or all of that 20% coinsurance, reducing your out-of-pocket costs further. Check with your Medigap insurer to confirm.

Sessions are billed using CPT code G0277 (hyperbaric oxygen, full body chamber, per 30 minutes). A standard 90-minute session is billed as three units. Medicare does not set a hard cap on the number of sessions — the number covered depends on medical necessity and ongoing documentation of healing progress, assessed every 30 days.

Does Medicare Advantage Cover Hyperbaric Oxygen Therapy?

Medicare Advantage (Part C) plans are required to cover everything that Original Medicare covers, which means they must cover HBOT for the same 14 FDA-approved conditions. However, the specific cost-sharing, prior authorization process, and in-network requirements vary by plan.

Key steps for Medicare Advantage patients:

1. Confirm the HBOT facility is in-network with your specific plan
2. Request prior authorization before beginning treatment — this is almost always required
3. Ask your plan for its specific clinical criteria, as some Advantage plans add criteria beyond the Medicare NCD

OxygenWell's billing team handles prior authorization requests for Medicare Advantage patients and works directly with plans to obtain approvals.

Does PPO Insurance Cover HBOT?

Most major PPO plans — including Blue Shield of California, Aetna, Cigna, and UnitedHealthcare — cover hyperbaric oxygen therapy for the same FDA-approved conditions recognized by Medicare. Several plans, including Aetna, also extend coverage to additional conditions such as avascular necrosis and sudden sensorineural hearing loss (SSNHL).

What PPO plans typically cover:

• All 14 Medicare-recognized FDA-approved HBOT conditions
• Prior authorization is required for non-emergency cases
• Medical records supporting the diagnosis and medical necessity must be submitted
• Some plans add coverage for conditions such as sudden hearing loss, avascular necrosis, and compromised surgical flaps from cosmetic procedures

OxygenWell accepts major PPO insurance plans and works with patients at both the Sherman Oaks and Calabasas locations to verify benefits and obtain approvals before the first session.

How to Verify Your HBOT Benefits Before Starting Treatment

Do not assume your plan covers HBOT without verifying first. Here is the step-by-step process:

1. Call the member services number on your insurance card. Ask specifically: "Does my plan cover hyperbaric oxygen therapy (CPT code G0277) for [your diagnosis]?"
2. Ask about prior authorization requirements. Most plans require it for non-emergency HBOT.
3. Ask about your deductible and coinsurance. Understand what you will owe per session and how much of your deductible has been met.
4. Ask if the facility is in-network. Confirm OxygenWell participates with your specific plan.
5. Let OxygenWell verify for you. OxygenWell's billing team can verify your benefits directly with your insurance company, often before your first consultation.

How to Get a Referral for Hyperbaric Oxygen Therapy

Most insurance plans require a physician referral or order before beginning HBOT. Here is how to get one:

Option 1: Ask your primary care physician (PCP). If you have a diabetic wound, radiation injury, bone infection, or other covered condition, your PCP can write a referral to OxygenWell. The referral letter should state the diagnosis, ICD-10 code, and medical necessity for HBOT.

Option 2: Ask your specialist. Oncologists, wound care surgeons, orthopedic surgeons, radiation oncologists, and vascular surgeons all regularly refer patients for HBOT. If you are a post-radiation patient, your radiation oncologist is the most natural source of a referral.

Option 3: Call OxygenWell directly. Dr. Beth Meneley and her team can conduct an initial consultation to evaluate whether HBOT is appropriate for your condition. If you qualify, they generate the treatment plan and work with your referring physician to coordinate care.

How OxygenWell Handles Insurance

OxygenWell is a physician-owned, Medicare-approved, and PPO-accepted hyperbaric oxygen therapy facility with locations in Sherman Oaks and Calabasas, California. Founded by Dr. Beth Meneley, DAOM, L.Ac. — who brings 25+ years in integrative medicine and 12+ dedicated years in hyperbaric medicine — OxygenWell has conducted more than 50,000 supervised HBOT sessions.

What makes OxygenWell different from many HBOT centers:

• Insurance-approved facility: OxygenWell meets the FDA, medical oversight, and safety standards required for insurance coverage. Many HBOT centers in Los Angeles do not.
• Physician-owned by California law: California requires hyperbaric facilities to be physician-owned for patient safety — a legal and insurance-eligibility differentiator.
• Dedicated billing support: A professional billing company handles all pre-authorizations, claim submissions, and appeals. You will not navigate insurance paperwork alone.
• Rated to 2.4 ATA with medical-grade oxygen: Full-rated monoplace chambers and a high-flow medical oxygen system — not a standard concentrator.
• On-site safety and medical oversight: A Safety Director with 12+ years of hyperbaric experience, a PA on-site most weekday hours, and telemedicine support from Medical Directors.

OxygenWell's insurance process:

1. Initial consultation with a physician to evaluate your condition and confirm HBOT candidacy
2. Insurance benefit verification by the billing team
3. Prior authorization submission with complete clinical documentation
4. Treatment begins once authorization is confirmed
5. Ongoing 30-day progress documentation to support continued coverage

What About Off-Label HBOT Conditions?

Medicare does not cover off-label HBOT uses such as Long COVID, TBI recovery, anti-aging, autism, or Lyme disease. Most PPO plans follow the same rule, though a small number of plans may consider coverage on a case-by-case basis for certain diagnoses if compelling clinical documentation is submitted.

If you are seeking HBOT for an off-label condition, OxygenWell offers transparent self-pay pricing and can design a personalized protocol based on your health goals. Dr. Meneley's functional medicine background means your program considers the whole picture — not just a single diagnosis.

Frequently Asked Questions

Does Medicare Part A cover hyperbaric oxygen therapy?

Medicare Part A covers inpatient hospital services. HBOT delivered in an inpatient setting may be covered under Part A as part of the inpatient stay. For outpatient HBOT at a clinic like OxygenWell, Medicare Part B applies.

How many HBOT sessions does Medicare cover?

There is no fixed session limit in the Medicare NCD. Coverage continues as long as the condition is progressing and the treating physician documents ongoing medical necessity. For diabetic wounds, progress must be evaluated every 30 days. If no measurable healing is occurring, coverage may be discontinued.

Can I get HBOT covered if my wound is Wagner Grade II?

Medicare specifically requires Wagner Grade III or higher for diabetic wound coverage. A Grade II wound does not meet the threshold. Your physician should assess whether the wound meets criteria for re-classification or whether self-pay HBOT is appropriate.

Does insurance cover HBOT after cosmetic surgery?

Generally, no — cosmetic procedures are not covered by insurance. However, if a post-surgical complication results in a compromised skin graft or flap with ischemia, that complication may qualify as a covered condition. OxygenWell treats many plastic surgery recovery patients and can evaluate whether your situation qualifies.

What happens if my insurance claim is denied?

OxygenWell's billing team will appeal denied claims. Common reasons for denials include incomplete documentation or failure to demonstrate that standard wound care was tried first. The team addresses these issues at the pre-authorization stage whenever possible to reduce the risk of denials before treatment begins.

Ready to Find Out If You Qualify?

If you have a condition that may qualify for covered HBOT, the first step is a consultation with OxygenWell's physicians. The team will evaluate your diagnosis, review your insurance benefits, and build a treatment plan designed around your specific needs.

OxygenWell | Hyperbaric and Regenerative Medicine Center
Sherman Oaks and Calabasas, California
Phone: (818) 661-0939
Website: www.oxygenwell.com

Advanced Technology. Medical Leadership. Unmatched Safety Standards.

This article is for informational purposes only and does not constitute medical or financial advice. Insurance coverage varies by plan and individual circumstances. Always verify benefits directly with your insurance provider and consult a qualified physician regarding your specific medical condition.