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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