Is HBO covered for wound care?
The national coverage decision for Hyperbaric Oxygen Therapy was expanded effective April 1, 2003, to allow treatment of diabetic wounds of the lower extremities provided the following conditions are met: · Patient has type I or II diabetes · Patient has a lower extremity wound due to diabetes · The wound is classified as Wagner grade III or higher · Patient has failed an adequate course of standard wound therapy (i.e. patient does not demonstrate any measurable signs of healing for at least 30 days with standard wound therapy). The NCD can be seen at the following link: http://cms.gov/mcd/viewncd.asp?ncd_id=35-10&ncd_version=8&show=all The NCD further defines “standard wound care” and stipulates how long HBO therapy could be covered. Specifically, wounds must be evaluated at least every 30 days for measurable signs of healing. If none have been demonstrated within any 30-day period, then ongoing HBO therapy would no longer be covered. CIGNA Government Services would review and expect
