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J Reconstr Microsurg
DOI: 10.1055/a-2616-3981
Original Article

Insurance Coverage for Hyperbaric Oxygen Therapy in Acutely Compromised Tissues

Matthew J. Heron 
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Katherine J. Zhu
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Annie B. McVeigh
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Siam K. Rezwan
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Carisa M. Cooney
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
,
Kristen P. Broderick
1   Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Abstract

Background

Beyond its indication for chronic wounds, hyperbaric oxygen therapy (HBOT) is an adjunct to managing acutely compromised grafts and flaps. Because physicians have reported challenges obtaining insurance coverage for HBOT, this cross-sectional analysis reviews policy requirements and presents an algorithm to enhance the odds of successful reimbursement.

Methods

We identified the 60 largest health insurers by market share and enrollment and collected their policies on HBOT. We then conducted a dual, blind extraction of policy details (e.g., continuing and prior authorization, documentation, treatment guidelines) and compiled these data into an insurance reimbursement algorithm to assist prescribing physicians.

Results

Fifty-three health insurers (88.3%) had policies on HBOT; 47.2% (n = 25) required prior authorization, and 61.9% (n = 13) required continuing authorization after a set number of HBOT sessions (median: 20 sessions, interquartile range [IQR]: 12–30 sessions). Thirty-eight (71.7%) permitted clinical judgment when defining flap or graft “compromise,” and 35.7% (n = 15) considered any pressure greater than 1 atmosphere absolute to be “hyperbaric.” Twenty-two insurers (41.5%) outlined documentation requirements for HBOT reimbursement; the most often requested documentation were medical records (n = 19, 86.4%), signs of healing (n = 12, 54.5%), images (n = 10, 45.5%), treatment goals (n = 8, 36.4%), and dive parameters (n = 5, 22.7%).

Conclusion

Most insured Americans are eligible for 12 sessions of HBOT; however, medical necessity must be established early and reconfirmed often to increase the likelihood of reimbursement. Additionally, prescribing physicians should be aware that insurers differ in their documentation, prior authorization, and continuing authorization requirements.

Keywords

hyperbaric oxygen therapy - grafts - flaps - insurance - complications

Note

This work was presented at the Practice Management Track abstract session during Plastic Surgery The Meeting 2024 in San Diego, CA.




Publication History

Received: 28 August 2024

Accepted: 12 May 2025

Article published online:
12 June 2025

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