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Medicine
Chapter 7
Section 20.1
Hyperbaric
Oxygen (HBO) Therapy
Issue Date: October 7, 1982
Copyright: CPT only © 2006 American Medical
Association (or such other date of publication of CPT).
All Rights Reserved.
Revision: C-30, August 15, 2018
1.0 CPT PROCEDURE CODE
99183
2.0 DESCRIPTION
HBO therapy is a mode of medical
treatment in which the patient is entirely enclosed in a pressure
chamber breathing oxygen at a pressure greater than one atmosphere.
3.0 POLICY
3.1 Benefits
are allowed for HBO therapy only when provided by an approved institutional provider,
such as a hospital.
3.2 HBO therapy
(CPT procedure code 99183) may be covered for the following indications:
• Decompression
sickness
• Carbon monoxide poisoning
• Air or gas embolism
• Profound blood loss, when blood
transfusion cannot be accomplished.
3.3 HBO therapy (CPT procedure
code 99183) may be covered as an adjunct to standard therapy for the
following indications:
• Acute
soft tissue injury (i.e., crush injury, compartment syndrome, acute
traumatic peripheral ischemia, blast injury)
• Clostridial
myositis and myonecrosis
• Compromised
skin grafts and/or flaps
• Chronic,
severe, and/or gangrenous diabetic foot wounds
• Ostoradionecrosis
• Osteomyelitis
refractory to standard medical management.
3.4 HBO may be covered for other
indications when documented by reliable evidence as safe, effective,
and comparable or superior to standard care (proven).
4.0 EXCLUSIONS
4.1 HBO therapy
for Traumatic Brain Injury (TBI) is unproven.
4.2 HBO therapy for stroke is unproven.
4.3 HBO therapy for cerebral palsy
is unproven.
4.4 HBO therapy for autism is unproven.
4.5 HBO therapy as an adjunct therapy
for the treatment of thermal burns is unproven.
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