Hyperbaric Oxygen Therapy, Topical Oxygen Therapy - Medicare Advantage

This policy covers hyperbaric oxygen therapy (HBOT) — including chamber-based HBOT and topical/continuous diffusion oxygen (CDO) systems — for Medicare Advantage members for conditions enumerated in CMS NCD 20.29 (examples include acute carbon monoxide poisoning, chronic refractory osteomyelitis, decubitus ulcers, acute peripheral arterial insufficiency/traumatic ischemia, crush injuries, and actinomycosis as an adjunct). Coverage is subject to applicable CMS NCDs/LCDs/LCAs and the member’s contract and jurisdictional MAC rules, may require confirmatory testing (e.g., vascular study for acute ischemia), is generally individualized for course and number of sessions, and in this excerpt emphasizes chamber-delivered HBOT (with topical systems considered per specific guidance).

"If bone healing delays and/or infection is present, 3 to 6 weeks of daily HBOT."

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