Hyperbaric and Topical Oxygen Therapies - (0053)

Cigna covers systemic hyperbaric oxygen (HBO) as first‑line therapy for acute CO poisoning, air/gas embolism, decompression sickness and select emergency blood‑loss situations, and as adjunctive therapy for numerous specified conditions (e.g., cyanide poisoning after antidote, traumatic peripheral ischemia, avascular necrosis, central retinal artery occlusion, refractory osteomyelitis, delayed radiation injuries, necrotizing soft‑tissue infection, ISSHL within 4 weeks, and Wagner grade ≥III diabetic foot ulcers refractory to standard care); topical oxygen therapy (TOT) is covered only as an adjunct for diabetic foot ulcers that have failed optimal standard care, while HBO/TOT are explicitly not covered for a long list of other indications (e.g., penile glans necrosis, TBI/brain injury, chronic wounds, COVID‑19, many neurologic/rheumatologic/infectious conditions). Coverage requires appropriate diagnosis/procedure codes and medical records documenting the qualifying diagnosis, prior/concurrent standard therapies and documented failure where specified (typically ≥4 weeks of SOC for DFUs), and condition‑specific evidence (e.g., audiometry for ISSHL, documentation of antidote for cyanide poisoning, objective wound measurements/photographs).