Save valuable time: Avoid having to file an appeal for HBO services

HBO is a modality in which the entire body is exposed to oxygen under increased atmospheric pressure. The patient is entirely enclosed in a pressure chamber breathing 100% oxygen (O2) at greater than one atmosphere (atm) pressure. Providers may use a mono-place chamber pressurized with pure O2, or a larger multi-place chamber pressurized with compressed air where the patient receives pure O2 by mask, head tent, or endotracheal tube.

Medicare reimbursement for HBO therapy is limited to that which is administered in a chamber (including the one-man unit) and to the conditions noted in the CMS internet-only manual (IOM), Publication 100-03, Medicare National Coverage Determinations Manual (NCD) for Hyperbaric Oxygen Therapy (20.29). 

Submit appropriate documentation 

For providers that received claim denials for HBO services and subsequently appealed the decision to First Coast, we often received insufficient medical record documentation that failed to support the medical necessity of the HBO therapy. The unfavorable redeterminations often lacked the following documentation: 

• Complete history and physical
• Progress notes
• Order for the service
• Advance beneficiary notice (ABN) 
• HBO treatment record to support the service was medically necessary and rendered as billed 

All other indications not specified under the regulations in the NCD are not covered under the Medicare program. No program payment may be made for HBO in the treatment of any conditions other than those identified.   

Proper documentation takes time, but it can help you avoid spending valuable administrative hours filing appeals if your documentation is thorough and complete the first time.