Podiatry Coding & Billing Alert

Question: Does Medicare cover HBO therapy to treat lower extremity diabetic wounds?

Texas Subscriber

Answer: Yes. For claims you submitted on/after April 1, 2000, Medicare will cover hyperbaric oxygen (HBO) therapy for lower extremity hypoxic and diabetic wounds for patients if they meet three specific criteria. First, the patient must have either Type I or Type II diabetes, as well as a lower extremity wound caused by the diabetes. Additionally, the wound must be classified as Wagner grade III or higher. And lastly, the patient must have failed an adequate course of standard wound therapy.

For the third criteria, Medicare goes into even more detail explaining the specifics. For example, Medicare will cover HBO therapy as adjunctive therapy only after the patient hasn’t shown any sign of measurable healing for at least 30 consecutive days under a standard wound therapy treatment plan. Also, the podiatrist must use the HBO therapy in addition to standard wound care. The podiatrist should evaluate the patient’s wound every 30 days while he administers the HBO therapy.

Don’t miss: Medicare will not cover continued wound treatment with the HBO therapy if the patient does not exhibit measurable signs of healing within the 30-day treatment period.