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HBOT Insurance Coverage: Does Insurance Cover Hyperbaric Oxygen?

When Medicare, Medicaid and private insurers pay for hyperbaric oxygen therapy: covered conditions, diabetic wound rules, prior authorization and billing codes.

September 14, 2026
10 min read
by Hyperbaric.app

This content is for informational purposes only and does not constitute medical advice. Always consult a healthcare professional. Read full disclaimer

Insurance usually covers hyperbaric oxygen therapy (HBOT) only for a defined list of medical conditions, and only when the treatment is medically necessary and well documented. In the US, Medicare covers 15 conditions, including decompression illness, carbon monoxide poisoning and certain diabetic foot wounds. Private insurers and state Medicaid programs set their own rules, but the policies we reviewed use similar condition lists. HBOT for wellness, anti-ageing, sports recovery or other off-label uses is generally not covered, so expect to pay yourself.

Last reviewed September 2026. Coverage rules change, so confirm the details with your insurer before you start treatment.

Does Medicare Cover Hyperbaric Oxygen Therapy?

Yes, for specific conditions. Under National Coverage Determination (NCD) 20.29, Medicare Part B covers HBOT given in a chamber (including one-person units) for:

  • acute carbon monoxide intoxication
  • decompression illness
  • gas embolism
  • gas gangrene
  • acute traumatic peripheral ischemia, and crush injuries or suturing of severed limbs, as an adjunct when loss of function, limb or life is threatened
  • progressive necrotizing infections (necrotizing fasciitis)
  • acute peripheral arterial insufficiency
  • preparation and preservation of compromised skin grafts (not for primary management of wounds)
  • chronic refractory osteomyelitis that has not responded to conventional medical and surgical management
  • osteoradionecrosis and soft tissue radionecrosis, as an adjunct to conventional treatment
  • cyanide poisoning
  • actinomycosis, only as an adjunct when antibiotics and surgery have failed
  • diabetic wounds of the lower extremities that meet the criteria below

According to Medicare.gov, you usually pay 20% of the Medicare-approved amount, and the Part B deductible may apply.

The same NCD lists 22 conditions Medicare does not cover. They include thermal burns, sickle cell anemia, multiple sclerosis, myocardial infarction, Alzheimer's disease, arthritic diseases, chronic peripheral vascular insufficiency, and cutaneous, pressure (decubitus) and stasis ulcers. Topical oxygen applied to a wound is not part of the NCD; since April 2017, regional Medicare contractors decide whether to cover it.

For how these conditions compare with the medical societies' lists, see our guide to HBOT indications.

Medicare's diabetic wound criteria

The rules for diabetic foot wounds are strict. All three of these must apply:

  1. You have type 1 or type 2 diabetes and a lower-extremity wound caused by diabetes.
  2. The wound is classified as Wagner grade III or higher.
  3. You have failed an adequate course of standard wound therapy.

HBOT is covered only as an add-on to standard wound care, and only after at least 30 days of that care without measurable signs of healing. Medicare defines standard care as assessing and correcting blood flow to the limb where possible, optimising nutrition and blood glucose, debridement to remove dead tissue, keeping a clean, moist wound bed with appropriate dressings, off-loading pressure, and treating any infection.

During HBOT, the wound must be evaluated at least every 30 days. If a 30-day period of treatment shows no measurable signs of healing, further HBOT is not covered. Some private insurers go further: Aetna requires wound photos with a ruler at least every 30 days. Keep your wound assessment appointments, because they are the evidence your coverage depends on. Our wound healing article explains what the research shows for these wounds.

Medicare Advantage plans

Medicare Advantage plans must follow Medicare's national and local coverage determinations, under a 2023 CMS final rule. The rule allows these plans to use prior authorization only to confirm the diagnosis or other medical criteria, or that a service is medically necessary. If you switch to a new Medicare Advantage coordinated care plan in the middle of a course of treatment, the new plan must give you a transition period of at least 90 days in which it cannot require prior authorization for that active treatment.

Do You Need Prior Authorization for HBOT?

Often, yes, although it depends on your plan.

  • Private insurers: many require it. Aetna, for example, publishes a dedicated HBOT precertification form for providers.
  • Medicaid: state programs can require prior approval. North Carolina's is described below.
  • Original Medicare: CMS tested mandatory prior authorization for non-emergency HBOT in Illinois, Michigan and New Jersey. The model ran from April 2015 to February 2018, and its evaluation found it cut quarterly HBOT spending for the targeted conditions by 32.2%. It found no effect on unplanned hospital admissions or deaths, and a very small (0.03 percentage point) rise in the chance of an emergency department visit for diabetic lower-extremity wounds.

Emergency treatment, such as for decompression illness or carbon monoxide poisoning, should never wait for paperwork. Call your local emergency number first.

Does Medicaid Cover Hyperbaric Oxygen Therapy?

Medicaid is run by each state, so covered conditions, prior approval rules and session limits vary. We have not surveyed all states. As one verified example, North Carolina Medicaid's clinical coverage policy 1A-8 (amended August 2023):

  • covers a list close to Medicare's, including decompression illness, gas embolism, carbon monoxide poisoning, necrotizing soft tissue infections, radiation injuries and Wagner grade III or higher diabetic wounds after 30 days of failed standard care
  • differs from Medicare in places, for example by naming central retinal artery occlusion and allowing chronic peripheral vascular insufficiency under strict conditions
  • requires prior approval before treatment, given for an initial 30 days, with a second request needed to continue beyond that
  • limits treatment to two sessions per date of service
  • does not cover autism, cerebral palsy, multiple sclerosis or traumatic brain injury

For under-21s, the federal EPSDT benefit can allow exceptions to a policy's limits when treatment is medically necessary, but not for experimental treatment, and prior approval still applies. To check your own state, look up your state Medicaid agency's HBOT policy or ask your Medicaid managed care plan for it.

Does Private Insurance Cover HBOT?

Private insurers set their own rules. Ask your insurer for its written medical policy on HBOT, because that is the document your claim will be judged against.

As an example, Aetna's Clinical Policy Bulletin 0172 treats systemic HBOT as medically necessary for 23 conditions, with a usual number of sessions for each. Its list covers all the conditions on the Undersea and Hyperbaric Medical Society (UHMS) indications list, sometimes with narrower criteria. That includes sudden sensorineural hearing loss, avascular necrosis, acute thermal burns and intracranial abscess, none of which are on Medicare's covered list. For diabetic wounds, Aetna requires non-healing, infected deep ulcers reaching tendon or bone (Wagner grade 3 or higher) after at least one month of wound care, and it stops covering HBOT if a 30-day period shows no measurable healing.

The same policy lists many uses as experimental, investigational or unproven, including autism spectrum disorders, COVID-19, traumatic brain injury, Alzheimer's disease, Lyme disease and cancer. Other insurers' policies differ, so check yours.

Is Wellness or Off-Label HBOT Covered?

Generally not. Uses outside the accepted indications, such as longevity, sports recovery or general wellness, do not appear on the covered lists in Medicare's NCD, Aetna's policy or North Carolina Medicaid's policy. Related uses such as cognitive impairment and chronic pain are named as experimental in Aetna's policy. UHMS also considers "mild" hyperbaric treatment below 1.5 ATA, the kind widely offered in wellness centres, to be unproven.

If you choose HBOT for one of these reasons, plan to pay yourself and ask for the full price of a course in writing before you start.

How to Ask a Clinic About Billing

A hyperbaric clinic that works with insurers should answer these questions easily:

  1. Which billing codes will you use? Two common codes are CPT 99183 (physician attendance and supervision of hyperbaric oxygen therapy, per session) and HCPCS G0277 (hyperbaric oxygen under pressure, full body chamber, per 30-minute interval), as listed in Aetna's policy. Your insurer can tell you how it pays for each.
  2. Which diagnosis will you submit, and is it on my plan's covered list?
  3. Will you request prior authorization, and can I see the approval before my first session?
  4. How many sessions are approved, and when is re-approval needed? For wounds, expect reviews about every 30 days.
  5. Is the facility in my plan's network?
  6. If it is not covered, what is the self-pay price per session and for the whole course?

We do not publish average HBOT prices by country: too few facilities list a price for an average to be meaningful, as noted in our directory statistics. You can find clinics near you and ask several for written quotes.

HBOT Coverage Outside the US

United Kingdom (NHS)

In England, NHS England routinely funds HBOT for decompression illness and gas embolism. Its 2024 consultation guide states that HBOT is not routinely commissioned for other indications, including carbon monoxide poisoning, necrotising soft tissue infections, radiation damage and diabetic foot ulcers. These rules are for NHS England; the rest of the UK has separate NHS bodies. Browse clinics in the United Kingdom.

Germany (statutory health insurance)

In Germany, the Federal Joint Committee (G-BA) decides which treatments statutory health insurance (GKV) pays for. In September 2017 it decided that people with severe diabetic foot syndrome can receive HBOT as an outpatient benefit, but only after standard treatment has failed, with qualified wound care before and during HBOT and a referral from specific specialist groups. According to the Hessen association of statutory health insurance physicians, eligible wounds reach at least the joint capsule or tendons (Wagner stage II), and the treating physician needs approval from their regional association to bill it. For other conditions, ask your Krankenkasse before starting. Browse clinics in Germany.

Other countries

Elsewhere, coverage depends on the condition and the national health system. The European Committee for Hyperbaric Medicine has recommended its accepted indications list as the basis for national reimbursement policies, so it is a useful starting point when you ask a European insurer. You can also browse clinics in the United States and other countries in the directory.

Sources

This article is general information, not medical, legal or financial advice. Insurance coverage depends on your specific plan and circumstances.

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