What Is Hyperbaric Medicine Used For? HBOT Indications List
The conditions UHMS, Europe's ECHM and Medicare accept for hyperbaric oxygen therapy, compared in one table, plus the evidence on off-label uses.
This content is for informational purposes only and does not constitute medical advice. Always consult a healthcare professional. Read full disclaimer
Hyperbaric medicine is used for a short, defined list of conditions. The main ones are decompression sickness, gas embolism, carbon monoxide poisoning, severe infections such as gas gangrene, late radiation injuries, crush injuries, failing skin grafts and flaps, sudden hearing loss, and selected diabetic foot wounds that have not healed with standard care. These are called accepted indications.
Three reference lists define them: the Undersea and Hyperbaric Medical Society (UHMS) in the United States, the European Committee for Hyperbaric Medicine (ECHM), and the US Medicare coverage policy. This article sets out all three, compares them in one table, and then looks at the popular uses that sit outside those lists.
What Counts as Medical Hyperbaric Oxygen Therapy?
UHMS defines hyperbaric oxygen therapy (HBOT) as a prescribed medical procedure. The whole body is inside a hard-sided chamber at a pressure of at least 2.0 atmospheres absolute (ATA), and the patient breathes medical-grade oxygen (more than 99% pure), typically for 90 to 120 minutes. UHMS adds that scientifically supported treatments are usually given at 1.9 to 3.0 ATA, and that most conditions need daily treatments over several weeks.
The indication lists below refer to this kind of treatment. UHMS describes "mild" hyperbaric sessions below 1.5 ATA, often with oxygen concentrations well under 95%, as unproven. In the US, the FDA's consumer guidance said it had cleared zippered soft chambers to treat altitude sickness only, and not for use with oxygen tanks or concentrators. One such 510(k) clearance describes a portable chamber for pressures under 4 psi, intended to treat mild symptoms of acute mountain sickness. Our guide to chamber types explains the difference between hard-shell and soft-shell chambers.
The UHMS Approved Indications
The UHMS indications list (15th edition of its indications manual) contains these conditions, in the society's order:
- Air or gas embolism
- Carbon monoxide poisoning, including carbon monoxide poisoning complicated by cyanide poisoning
- Clostridial myositis and myonecrosis (gas gangrene)
- Crush injury, compartment syndrome and other acute traumatic ischemias
- Decompression sickness
- Arterial insufficiencies: central retinal artery occlusion, and enhancement of healing in selected problem wounds
- Severe anemia
- Intracranial abscess
- Necrotizing soft tissue infections
- Osteomyelitis (refractory)
- Delayed radiation injury (soft tissue and bony necrosis)
- Compromised grafts and flaps
- Acute thermal burn injury
- Idiopathic sudden sensorineural hearing loss (approved by the UHMS Board of Directors on 8 October 2011)
- Avascular necrosis (aseptic osteonecrosis)
UHMS also notes that HBOT for traumatic brain injury has been studied in several randomised trials but is still considered investigational.
The ECHM Accepted Indications in Europe
Europe's reference list comes from the Tenth European Consensus Conference on Hyperbaric Medicine, held in Lille in April 2016 and published by Mathieu, Marroni and Kot in 2017. Each condition received a recommendation type and an evidence grade:
- Type 1: strong recommendation ("we recommend")
- Type 2: weaker recommendation ("we suggest")
- Type 3: neutral recommendation ("it would be reasonable"), an optional measure
- Grade B means moderate evidence and grade C low evidence. No accepted indication reached grade A.
Type 1 (strongly recommended): carbon monoxide poisoning (B), open fractures with crush injury (B), prevention of osteoradionecrosis after dental extraction (B), osteoradionecrosis of the mandible (B), soft tissue radionecrosis such as radiation cystitis and proctitis (B), decompression illness (C), gas embolism (C), anaerobic or mixed bacterial infections (C) and sudden deafness (B).
Type 2 (suggested): diabetic foot lesions (B), femoral head necrosis (B), compromised skin grafts and musculocutaneous flaps (C), central retinal artery occlusion (C), crush injury without fracture (C), osteoradionecrosis of bones other than the mandible (C), radiation injury of other soft tissues (C), preventive treatment for surgery and implants in irradiated tissue (C), ischaemic ulcers (C), refractory chronic osteomyelitis (C), second-degree burns covering more than 20% of body surface area (C), pneumatosis cystoides intestinalis (C) and stage IV neuroblastoma (C).
Type 3 (optional, all grade C): brain injury in highly selected patients (acute and chronic traumatic brain injury, chronic stroke, post-anoxic encephalopathy), radiation injury of the larynx or central nervous system, post-vascular procedure reperfusion syndrome, limb replantation, selected non-healing wounds caused by systemic disease, sickle cell disease and interstitial cystitis.
Not recommended: the conference advised against HBOT for autism spectrum disorders, multiple sclerosis, cerebral palsy and tinnitus (Type 1, grade B), and for placental insufficiency and the acute phase of stroke (Type 1, grade C).
The evidence grades in the originally printed table were shifted by one column, and the authors published a correction in June 2017. The grades above follow the corrected version. The conference also recommended that European centres use this list as the basis for accreditation and national reimbursement policies.
ECHM re-voted the list in September 2026
The ECHM held its 11th Consensus Conference on Indications for Hyperbaric Oxygen Therapy on 14 September 2026, at the EUBS 2026 congress in Geneva. Type 1, Type 2/3 and emerging indications were each discussed and voted on, and the jury's conclusions were presented on 18 September. According to EUBS, the full Recommendations Report will be finalised after further Delphi rounds and published by the end of 2026.
Until that report is published, the 2016 list above is still the current European reference. Our EUBS 2026 article explains what was reviewed. We will update this page when the revised list is published.
Medicare-Covered Conditions (NCD 20.29)
In the US, Medicare's National Coverage Determination 20.29 decides what Medicare pays for. It is a coverage rule rather than a clinical guideline. Medicare 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, as an adjunct when loss of function, limb or life is threatened
- Crush injuries and suturing of severed limbs, on the same terms
- 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, as an adjunct to conventional treatment
- Soft tissue radionecrosis, as an adjunct to conventional treatment
- Cyanide poisoning
- Actinomycosis, only as an adjunct when the disease has not responded to antibiotics and surgery
- Diabetic wounds of the lower extremities, when the patient has type 1 or type 2 diabetes, the wound is Wagner grade III or higher, and an adequate course of standard wound therapy has failed
For diabetic wounds, HBOT is covered only after at least 30 days of standard wound care without measurable signs of healing. Coverage stops if a 30-day period of HBOT shows no measurable healing. The same policy lists 22 conditions Medicare does not cover, including thermal burns, sickle cell anemia, multiple sclerosis, myocardial infarction, Alzheimer's disease, and pressure (decubitus) and stasis ulcers. Our HBOT insurance coverage guide explains how this works in practice.
UHMS vs ECHM vs Medicare: Side-by-Side
"Not listed" means the condition does not appear by name on that list. ECHM entries show recommendation type and evidence grade.
| Condition | UHMS | ECHM (2016) | Medicare NCD 20.29 |
|---|---|---|---|
| Decompression sickness / illness | Approved | Type 1 (C) | Covered |
| Air or gas embolism | Approved | Type 1 (C) | Covered |
| Carbon monoxide poisoning | Approved | Type 1 (B) | Covered (acute) |
| Cyanide poisoning | Approved when combined with CO poisoning | Not listed | Covered |
| Gas gangrene (clostridial myonecrosis) | Approved | Type 1 (C), as an anaerobic infection | Covered |
| Necrotizing soft tissue infections | Approved | Type 1 (C) | Covered |
| Intracranial abscess | Approved | Type 1 (C), in defined cases | Not listed |
| Crush injury and acute traumatic ischemia | Approved | Type 1 (B) with open fracture; Type 2 (C) without fracture | Covered when limb, function or life is threatened |
| Central retinal artery occlusion | Approved | Type 2 (C) | Not listed by name |
| Diabetic foot wounds | Approved (selected problem wounds) | Type 2 (B) | Covered if Wagner grade III or higher after failed standard care |
| Osteoradionecrosis (radiation injury to bone) | Approved | Type 1 (B) for the mandible; Type 2 (C) for other bones | Covered (adjunct) |
| Soft tissue radiation injury | Approved | Type 1 (B) for cystitis and proctitis; Type 2 (C) for other sites | Covered (adjunct) |
| Refractory osteomyelitis | Approved | Type 2 (C) | Covered |
| Compromised skin grafts and flaps | Approved | Type 2 (C) | Covered (grafts) |
| Thermal burns | Approved | Type 2 (C) for second-degree burns over 20% of body surface | Not covered |
| Sudden sensorineural hearing loss | Approved | Type 1 (B) | Not listed |
| Avascular (femoral head) necrosis | Approved | Type 2 (B) | Not listed |
| Severe anemia | Approved | Not listed | Not covered (exceptional blood loss anemia) |
| Actinomycosis | Not listed | Not listed | Covered (adjunct) |
| Sickle cell disease | Not listed | Type 3 (C) | Not covered |
| Traumatic brain injury | Not listed (investigational) | Type 3 (C), highly selected patients | Not listed |
| Multiple sclerosis | Not listed | Not recommended | Not covered |
| Autism spectrum disorders | Not listed | Not recommended | Not listed |
| Acute stroke | Not listed | Not recommended | Not covered (cerebral vascular insufficiency) |
The main differences are worth knowing. Sudden hearing loss and femoral head necrosis are accepted by both medical societies but are not named in Medicare's covered list. Burns are approved by UHMS and suggested by ECHM, yet Medicare lists thermal burns as non-covered. Medicare covers actinomycosis, which neither society lists.
Off-Label and Wellness Uses: What the Evidence Says
Many clinics offer HBOT for conditions that appear on none of these lists. That does not prove the treatment cannot help, but it means the evidence has not convinced expert panels, and insurers rarely pay. The FDA's consumer update on HBOT (last updated July 2021, now archived) listed 13 conditions for which hyperbaric chambers were cleared, stated that no HBOT device was cleared for any other condition, and warned that HBOT is not proven to cure cancer, Lyme disease, autism or Alzheimer's disease. Aetna's HBOT policy (CPB 0172), for example, classes HBOT for autism, COVID-19, traumatic brain injury, Alzheimer's disease, Lyme disease and cancer as experimental.
Brain injury and stroke
A 2012 Cochrane review of 7 trials with 571 people found that adding HBOT to standard care after traumatic brain injury may reduce the risk of death. There was little evidence that survivors had a good outcome, the trials were small with a significant risk of bias, and the authors concluded routine use could not be justified. ECHM recommends HBOT for traumatic brain injury only within ethics-approved research, and advises against it in the acute phase of stroke. More in our brain health article.
Autism
A 2016 Cochrane review found one eligible trial, with 60 children. It reported no improvement in social interaction, communication, behaviour or cognition, and more minor ear barotrauma in the HBOT group. ECHM advises against HBOT for autism. See our autism article for the wider research picture.
Long COVID
A 2022 randomised, sham-controlled trial in Israel gave 73 patients either 40 HBOT sessions or sham sessions. The HBOT group showed improvements in cognitive function, energy, sleep, psychiatric symptoms and pain, measured one to three weeks after the last session. It is a single small trial with short follow-up, and some authors declared employment by or shares in AVIV Scientific. COVID-19 is on ECHM's emerging-indications agenda for 2026 but is not an accepted indication. Read more in our long COVID article.
Longevity and ageing
A 2020 prospective study gave 35 healthy adults aged 64 and over 60 daily sessions. Telomere length in several immune cell types rose by more than 20%, and senescent T-helper cells fell. There was no control group, the outcomes were blood-cell markers rather than health or lifespan, and several authors declared ties to AVIV Scientific. No expert body lists ageing as an indication. See our longevity article.
Wounds outside the criteria
Even for diabetic foot ulcers, the evidence is mixed. A 2015 Cochrane review of 12 trials (577 participants) found better ulcer healing at six weeks, but the benefit was not evident at one year, and the difference in major amputations was not statistically significant. This is one reason coverage rules are narrow. Our wound healing article covers this in detail.
Do All Hospitals Have a Hyperbaric Chamber?
No. Most hospitals do not have one, and many chambers that do exist cannot take emergency patients.
United States. The American Hospital Association counts about 6,100 hospitals in the US. A 2016 national survey of hyperbaric programmes found that only 43 of 361 centres (11.9%) had the ventilators, infusion pumps and staff needed to treat high-acuity emergency patients. Patients with severe decompression sickness or carbon monoxide poisoning may therefore need transfer. Hyperbaric.app lists 660 facilities in the United States.
United Kingdom. In England, NHS England routinely funds HBOT only for decompression illness and gas embolism. In 2023/24 that service ran from 8 centres operated by 7 independent providers, and a 2024 consultation proposed reducing them to 6. In May 2025, diving organisations reported that new contracts covered only three regions. Hyperbaric.app lists 189 facilities in the United Kingdom, so most of them are outside NHS England's emergency network.
Germany. Statutory health insurance covers outpatient HBOT for severe diabetic foot syndrome after standard therapy has failed, following a 2017 decision by the Federal Joint Committee (G-BA). Hyperbaric.app lists 27 facilities in Germany.
Our directory statistics show how listed facilities are spread by country and chamber type. These are facilities verified by hyperbaric.app, not a census of every chamber.
In an emergency
If you suspect decompression sickness or carbon monoxide poisoning, call your local emergency number first. Divers can then call the Divers Alert Network emergency hotline on +1-919-684-9111. Emergency HBOT is given in hospital-based chambers with critical care support, not at wellness centres. See our guides to HBOT for decompression sickness and HBOT for carbon monoxide poisoning.
Sources
- Undersea and Hyperbaric Medical Society, Indications for hyperbaric oxygen therapy (includes the UHMS definition of HBOT and statement on mild hyperbaric treatment)
- Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving and Hyperbaric Medicine. 2017;47(1):24-32.
- Mathieu D, Marroni A, Kot J. Correction to: Tenth European Consensus Conference on Hyperbaric Medicine. Diving and Hyperbaric Medicine. 2017;47(2):131-132.
- EUBS 2026 congress, programme
- European Underwater and Baromedical Society, post-congress announcement (11th ECHM Consensus Conference; report due by the end of 2026; accessed 22 September 2026)
- Centers for Medicare and Medicaid Services, National Coverage Determination 20.29: Hyperbaric Oxygen Therapy
- US Food and Drug Administration, Hyperbaric Oxygen Therapy: Get the Facts (consumer update, content current as of 26 July 2021; archived copy, the page has been removed from fda.gov)
- US Food and Drug Administration, 510(k) summary K101262: Flexi-Lite hyperbaric chamber (2010)
- Aetna, Clinical Policy Bulletin 0172: Hyperbaric Oxygen Therapy (HBOT)
- Bennett MH, Trytko B, Jonker B. Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injury. Cochrane Database of Systematic Reviews. 2012;12:CD004609.
- Xiong T, Chen H, Luo R, Mu D. Hyperbaric oxygen therapy for people with autism spectrum disorder (ASD). Cochrane Database of Systematic Reviews. 2016;10:CD010922.
- Zilberman-Itskovich S, Catalogna M, Sasson E, et al. Hyperbaric oxygen therapy improves neurocognitive functions and symptoms of post-COVID condition: randomized controlled trial. Scientific Reports. 2022;12(1):11252.
- Hachmo Y, Hadanny A, Abu Hamed R, et al. Hyperbaric oxygen therapy increases telomere length and decreases immunosenescence in isolated blood cells: a prospective trial. Aging (Albany NY). 2020;12(22):22445-22456.
- Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE, Weibel S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews. 2015;(6):CD004123.
- Chin W, Jacoby L, Simon O, et al. Hyperbaric programs in the United States: locations and capabilities of treating decompression sickness, arterial gas embolisms, and acute carbon monoxide poisoning: survey results. Undersea and Hyperbaric Medicine. 2016;43(1):29-43.
- American Hospital Association, Fast Facts on U.S. Hospitals
- NHS England, Reviewing hyperbaric oxygen services: consultation guide (September 2024)
- DIVE Magazine, NHS England to close four more hyperbaric chambers (May 2025)
- Gemeinsamer Bundesausschuss, Hyperbare Sauerstofftherapie bei schwerem diabetischen Fußsyndrom (press release, in German, 21 September 2017)
- Divers Alert Network, Medical services and emergency hotline
This article is for information only and is not medical advice. Whether HBOT is appropriate for you should be decided with a qualified physician.