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HBO Physician Orders Overview



Hyperbaric oxygen therapy (HBOT) is a modality in which the entire body is exposed to oxygen (100%) under increased atmospheric pressure (>1 atm).  This is conducted in either a monoplace chamber, dual place chamber, or multiplace chamber.  

What is a Physician Order Set?

Medicare, Medicaid and federally funded payers have specific coverage and documentation requirements for HBOT. An order set is a grouping of orders, used to standardize and expedite the ordering process. The Physician Order Sets establish guidelines outlining the documentation required to support hyperbaric oxygen therapy in accordance with Medicare, Medicaid and other federally funded payer guidelines.  

When is a Physician Order  needed?

Physician Orders are required prior to the initiation of Hyperbaric oxygen therapy.  The order may be for a single treatment or for a course of therapy. The documentation presented in the clinical record must provide an accurate description and diagnosis of the medical condition supporting that the use of HBOT is reasonable and medically necessary.

What should a Physician Order include?

The physician order for Hyperbaric Oxygen Therapy must include but is not limited to the following:

  • Hyperbaric diagnosis and Treatment protocol.
  • Specific pre-HBOT diagnostics necessary
  • Date on which HBOT is to begin
  • Treatment Pressure (depth) and oxygen breathing period
  • Total treatment time
  • Air breaks – when indicated or per treatment protocol
  • TCOM’s (as appropriate to patient condition)
  • Total estimated number of treatment sessions

At a minimum, the following elements should be provided on the physician order form as well:

  • Signature,  date and time of the order.
  • The patient’s name, date of birth and medical record/account number.  
  • The name of physician or authorized individual ordering hyperbaric oxygen services.
  • Authentication of physician or authorized individual ordering hyperbaric oxygen services.

Orders from Physicians that are not institutionally credentialed as a qualified Hyperbaric provider will not be accepted

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Indications Sample Physician Order



Acute Carbon Monoxide 

Acute Exceptional Blood Loss Anemia

 Acute Peripheral Arterial Insufficiency

Acute Traumatic Peripheral Ischemia

Cerebral Arterial Gas Embolism - Initial Treatment

Cerebral Arterial Gas Embolism - Follow up

Chronic Refractory Osteomyelitis

Clostridial Myonecrosis

Compromised Skin Graft/Flap

Crush Injuries and Suturing of Severed Limbs

Cyanide Poisoning

Decompression Sickness - Initial Treatment

Decompression Sickness - Follow up

Diabetic Ulcer - Lower Extremity

Idiopathic Sudden Sensorineural Hearing Loss

Intracranial Abscess

Late Radiation Tissue Prophylaxis

Necrotizing Soft Tissue Infection

Osteoradionecrosis of the Mandible

Soft Tissue Radionecrosis

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