By Indication

• Chronic Refractory Osteomyelitis
• Osteoradionecrosis - Mandibular
• Soft Tissue Radiation Injury
• Diabetic Foot Ulcer
• Compromised Skin Grafts and Flaps, digit/limb replantation

See all indications below in "Evidence-based indications accepted by the UHMS, approved by Medicare" and "Evidence-based indications accepted by the UHMS, NOT approved by Medicare"

By Treatment Protocol

Table 1: 90 minutes of oxygen breathing at 2 ATA without air break 

Table 1 based on Kindwall and Whelan [2] and National Baromedical Services [3]

Indications:         

Table 2: 90 minutes of oxygen breathing at 2 ATA with air break 

(patients with high seizure risk)

Table 2 based on Kindwall and Whelan [2] and National Baromedical Services [3]

Indications:

Table 3: 90 minutes oxygen breathing at 2.5 ATA with 2 air breaks 

Table 3 based on Kindwall and Whelan [2] and National Baromedical Services [3]

Indications:        

Table 4a: 90 minutes oxygen breathing at 3 ATA with 2 air breaks

Table 4a based on Kindwall and Whelan [2] and National Baromedical Services [3]

Indications:

Table 4b: Weaver Protocols for Carbon Monoxide Poisoning 

Table 4b based on Weaver et al [4]

Table V

Adapted from the U.S. Navy Diving Manual  [5]

1. Descent Rate – 20 ft/min.
2. Ascent Rate – Not to exceed 1 ft/min. Do not compensate for slower ascent rates. Compensate for faster rates by halting the ascent.
3. Time on oxygen begins on arrival at 60 feet.
4. If oxygen breathing must be interrupted because of CNS Oxygen Toxicity, allow 15 minutes after the reaction has entirely subsided and resume schedule at point of interruption
5. Treatment Table may be extended two oxygen-breathing periods at the 30-foot stop. No air break required between oxygen-breathing periods or prior to ascent.
6. Tender breathes 100% O2 during ascent from the 30-foot stop to the surface. If the tender had a previous hyperbaric exposure in the previous 12 hours, an additional 20 minutes of oxygen breathing is required prior to ascent.

Note: In a hyperbaric monoplace chamber operating on psi measurements, decompress at a rate of: 1 psi/2 min

• 30 fsw = 13.3 psi (1.9 ATA)
• 60 fsw = 26.7 psi (2.8 ATA)

Table VI

Adapted from the U.S. Navy Diving Manual [5]

1. Descent Rate – 20 ft/min.
2. Ascent Rate – Not to exceed 1 ft/min. Do not compensate for slower ascent rates. Compensate for faster rates by halting the ascent.
3. Time on oxygen begins on arrival at 60 feet.
4. If oxygen breathing must be interrupted because of CNS Oxygen Toxicity, allow 15 minutes after the reaction has entirely subsided and resume schedule at point of interruption
5.  Table 6 can be lengthened up to 2 additional 25-minute periods at 60 feet (20 minutes on oxygen and 5 minutes on air), or up to 2 additional 75-minute periods at 30 feet (15 minutes on air and 60 minutes on oxygen), or both.
6. Tender breathes 100% O2 during the last 30 minutes at 30 fsw and during ascent to the surface for an unmodified table or where there has been only a single extension at 30 or 60 feet. If there has been more than one extension, the O2 breathing at 30 feet is increased to 60 minutes. If the tender had a hyperbaric exposure within the past 12 hours, an additional 60-minute O2 period is taken at 30 feet.

Note:  In a hyperbaric monoplace chamber operating on psi measurements, decompress at a rate of: 1 psi/2 min

• 30 fsw = 13.3 psi (1.9 ATA)
• 60 fsw = 26.7 psi (2.8 ATA)

By Threshold Level

For a separate view of the table below, along with the treatment tables, see  HBO Threshold Levels

      *   If the patient receives less than the indicated lower treatment threshold, a case audit is to be undertaken. For these disorders, too few treatments may be unlikely to have sufficient therapeutic effect and potentially waste resources. Reasons for early termination of HBO therapy may include: death; misdiagnosis; non-compliance; deterioration, or failure to perceive improvement.

  **   For patients treated more than three days after clinical plateau.

  ‡   Recommendations of the Undersea and Hyperbaric Medical Society, Hyperbaric Oxygen therapy Indications 13th Edition, 2014.

HYPERBARIC CPT CODES

• 99183 Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session (PROFESSIONAL CHARGE)
• G0277 Hyperbaric oxygen under pressure, full body chamber, per 30 minute intervaL (FACILITY CHARGE)

TREATMENT

Evidence-based indications accepted by the UHMS, approved by Medicare

Elective – Chronic Indications

• Chronic Refractory Osteomyelitis                                          
• Diabetic Foot Ulcer - Hyperbaric Oxygen Therapy
• Osteoradionecrosis - Mandibular                                                                   
• Soft Tissue Radiation Injury                                                                     

Emergent/Urgent – Acute Indications

• Acute Carbon Monoxide Poisoning
• Acute Traumatic Peripheral Ischemias
• Crush Injury
• Acute peripheral arterial insufficiency
  
• Arterial Gas Embolism
  
• Clostridial Myonecrosis (Gas Gangrene)
  
• Compromised Skin Grafts and Flaps, digit/limb replantation
• Decompression Illness
• Necrotizing Soft Tissue Infections and Fournier's Gangrene

Evidence-based indications accepted by the UHMS, NOT approved by Medicare

Elective – Chronic Indications

• Pyogenic and Invasive Fungal Intracranial Abscesses
• Problem Wound Support
• Late Radiation Tissue Prophylaxis

Emergent/Urgent – Acute Indications

• Acute Exceptional Blood Loss Anemia
  
• Acute Retinal Artery Insufficiency
  
• Acute Thermal Burns
• Idiopathic Sudden Sensorineural Hearing Loss