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HBO Documentation Checklist

HBO Documentation Checklist

HBO Documentation Checklist


  • Current Procedural Terminology (CPT®) code 99183: Physician or other qualified healthcare professional attendance and supervision of hyperbaric oxygen therapy, per session. 
  • HCPCS Code G0277: Hyperbaric oxygen under pressure, full-body chamber, per 30-minute interval


The following areas should be considered to minimize errors and be audit-ready:

  • Documentation to support the dates of service billed may include, but is not limited to:
    • Treatment records (Dive sheets)
    • Signed DAILY order for HBO services
  • Documentation to support medically necessity may include, but is not limited to:
    • Documentation to support services for treating a condition as described in CMS Pub 100-03, Medicare National Coverage Determination (NCD) Manual, Chapter 1, Coverage Determination, Section 20.29, Hyperbaric Oxygen therapy. [1]
    • History and Physical that clearly describes the condition for which HBOT is recommended
    • Physician progress note(s) that support all adjunctive therapies provided to the beneficiary in the treatment of the diagnosed condition
    • Laboratory and pathology report(s) if applicable
    • Radiology reports if applicable
    • Vascular studies if applicable
    • Documentation to support (at minimum) 30 days of failed conservative treatment(s) of wound with wound measurements if applicable
    • Operative and/or procedure reports related to the diagnosis if applicable
    • Date and anatomical site of radiation treatment if applicable
    • Prior antibiotic administration record to support chronic condition if applicable (i.e. chronic osteomyelitis)
    • HBOT procedure log(s) to include ascent time, decent time and pressurization level
    • Direct physician supervision
    • Assessment of condition (minimum) every 30 days during the HBOT
    • For condition where HBOT is covered when there is a threatened loss of function, limb, or life, the documentation must support the condition.
    • Advance Beneficiary Notice (ABN) if applicable 
    • Signature log or attestation statement for any missing or illegible signature within the medical record

    • Sections with detailed documentation requirements, templates, and checklists for each specific HBOT indication can be found within each topic of the HBO Knowledge Base. See list of HBOT indications in " HBO Treatment Indications With Protocols".

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    NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.


    1. . CMS NCD 20.29 .;.
    Topic 1032 Version 1.0