TMPPM 2008 > Texas Medicaid Services > Hospital (Medical/Surgical Acute Care Facility) > Outpatient

   
 

25.3.3.26 Hyperbaric Oxygen Therapy (HBO)

HBO is a type of therapy that is intended to increase the environmental oxygen pressure to promote the movement of oxygen from the environment into the body tissues by means of pressurization that is greater than atmospheric pressure. Such treatment is performed in specially constructed hyperbaric chambers, which may hold one or several patients.

Note: Although oxygen may be administered by mask, cannula, or tube in addition to the hyperbaric treatment, the use of oxygen by mask, etc., or applied topically is not considered hyperbaric treatment in itself.

HBO will be limited to one session per day, any provider using procedure code 1-99183.

Outpatient hospital clinics and hospital-based rural health centers must use revenue code B-413, Respiratory services, HBO, (quantity of one) for reimbursement of the technical component.

The FDA-approved indications for the hyperbaric oxygen chamber (therapy) in accordance with the guidelines established by the Undersea and Hyperbaric Medical Society are as follows:

Air or gas embolism.

Carbon monoxide/smoke inhalation.

Compromised skin grafts and flaps.

Crush injuries/acute traumatic ischemias.

Decompression sickness.

Enhanced healing in selected problem wounds.

Exceptional blood loss (anemia).

Gas gangrene (clostridial myonecrosis).

Intracranial abscess.

Necrotizing soft tissue infections.

Radiation tissue damage (osteoradionecrosis).

Refractory osteomyelitis.

Thermal burns.

When requesting reimbursement of HBO for the treatment of air or gas embolism the following diagnosis codes should be used:

Diagnosis Codes

6396

67300

9580

9991

When requesting reimbursement of HBO for the treatment of carbon monoxide/smoke inhalation use diagnosis code 986.

When requesting reimbursement of HBO for the treatment of compromised skin grafts and flaps the following diagnosis codes should be used:

Diagnosis Codes

99652

99660

99661

99662

99663

99664

99665

99666

99667

99668

99669

99670

99671

99672

99673

99674

99675

99676

99677

99678

99679

V423

When requesting reimbursement of HBO for the treatment of crush injuries/acute traumatic ischemias the following diagnosis codes should be used:

Diagnosis Codes

8690

8691

8871

8873

8875

8877

8971

8973

8975

8977

9251

9252

9260

92611

92612

92619

9268

9269

92700

92701

92702

92703

92709

92710

92711

92720

92721

9273

9278

9279

92800

92801

92810

92811

92820

92821

9283

9288

9289

9290

9299

99690

99691

99692

99693

99694

99695

99696

99699

When requesting reimbursement of HBO for the treatment of decompression sickness use diagnosis code 9933.

When requesting reimbursement of HBO for the treatment of enhanced healing in selected problem wounds the following diagnosis codes should be used:

Diagnosis Codes

25070

25071

25072

25073

44023

44024

44381

44382

44389

4439

4540

4542

68600

68601

68609

70700

70701

70702

70703

70704

70705

70706

70707

70709

70710

70711

70712

70713

70714

70715

70719

7078

7079

9895

99859

When requesting reimbursement of HBO for the treatment of exceptional blood loss (anemia) the following diagnosis codes should be used:

Diagnosis Codes

2851

78552

78559

9584

9980

When requesting reimbursement of HBO for the treatment of gas gangrene (clostridial myonecrosis) diagnosis codes 0383 and 0400 should be used.

When requesting reimbursement of HBO for the treatment of necrotizing soft tissue infections diagnosis codes 72886 and 7854 should be used.

When requesting reimbursement of HBO for the treatment of radiation tissue damage (osteoradionecrisis) the following diagnosis codes should be used:

Diagnosis Codes

73010

73011

73012

73013

73014

73015

73016

73017

73018

73019

7854

9092

990

When requesting reimbursement of HBO for the treatment of refractory osteomyelitis the following diagnosis codes should be used:

Diagnosis Codes

73010

73011

73012

73013

73014

73015

73016

73017

73018

73019

When requesting reimbursement of HBO for the treatment of thermal burns the following diagnosis codes should be used:

Diagnosis Codes

9400

9401

9402

9403

9404

9405

9409

94100

94101

94102

94103

94104

94105

94106

94107

94108

94109

94110

94111

94112

94113

94114

94115

94116

94117

94118

94119

94120

94121

94122

94123

94124

94125

94126

94127

94128

94129

94130

94131

94132

94133

94134

94135

94136

94137

94138

94139

94140

94141

94142

94143

94144

94145

94146

94147

94148

94149

94150

94151

94152

94153

94154

94155

94156

94157

94158

94159

94200

94201

94202

94203

94204

94205

94209

94210

94211

94212

94213

94214

94215

94219

94220

94221

94222

94223

94224

94225

94229

94230

94231

94232

94233

94234

94235

94239

94240

94241

94242

94243

94244

94245

94249

94250

94251

94252

94253

94254

94255

94259

94300

94301

94302

94303

94304

94305

94306

94309

94310

94311

94312

94313

94314

94315

94316

94319

94320

94321

94322

94323

94324

94325

94326

94329

94330

94331

94332

94333

94334

94335

94336

94339

94340

94341

94342

94343

94344

94345

94346

94349

94350

94351

94352

94353

94354

94355

94356

94359

94400

94401

94402

94403

94404

94405

94406

94407

94408

94410

94411

94412

94413

94414

94415

94416

94417

94418

94420

94421

94422

94423

94424

94425

94426

94427

94428

94430

94431

94432

94433

94434

94435

94436

94437

94438

94440

94441

94442

94443

94444

94445

94446

94447

94448

94450

94451

94452

94453

94454

94455

94456

94457

94458

94500

94501

94502

94503

94504

94505

94506

94509

94510

94511

94512

94513

94514

94515

94516

94519

94520

94521

94522

94523

94524

94525

94526

94529

94530

94531

94532

94533

94534

94535

94536

94539

94540

94541

94542

94543

94544

94545

94546

94549

94550

94551

94552

94553

94554

94555

94556

94559

9460

9461

9462

9463

9464

9465

9470

9471

9472

9473

9474

9478

9479

94800

94810

94811

94820

94821

94822

94830

94831

94832

94833

94840

94841

94842

94843

94844

94850

94851

94852

94853

94854

94855

94860

94861

94862

94863

94864

94865

94866

94870

94871

94872

94873

94874

94875

94876

94877

94880

94881

94882

94883

94884

94885

94886

94887

94888

94890

94891

94892

94893

94894

94895

94896

94897

94898

94899

9490

9491

9492

9493

9494

9495

HBO that exceeds one session per day, any provider will be denied.


Texas Medicaid & Healthcare Partnership
CPT only copyright 2007 American Medical Association. All rights reserved.
PreviousNextIndex