CSHCN 2008 >24.3.15 Hyperbaric Oxygen Therapy (HBOT)

Hyperbaric oxygen (HBO) is a type of therapy involving exposure of the body to oxygen under pressure greater than one atmosphere. Treatment is performed in specially constructed hyperbaric chambers that may hold one or several patients. HBOT services must be provided in facilities that have experience in HBO treatment of pediatric clients, and a physician trained in HBOT should be available throughout the therapy session. Although oxygen may be administered by mask, cannula, or tube in addition to the hyperbaric treatment, this use of oxygen is not considered HBOT in itself.

HBOT treatments must be authorized. Use procedure code 1-99183 to bill HBOT. HBOT is a benefit of the CSHCN Services Program for the following diagnosis codes


Diagnosis Code	Description
0383	Septicemia due to anaerobes
0400	Gas gangrene
52689	Other specified diseases of the jaws
68600	Pyoderma, unspecified
68601	Pyoderma gangrenosum
68609	Other pyoderma
70701	Decubitus ulcer, elbow
70702	Decubitus ulcer, upper back
70703	Decubitus ulcer, lower back
70704	Decubitus ulcer, hip
70705	Decubitus ulcer, buttock
70706	Decubitus ulcer, ankle
70707	Decubitus ulcer, heel
70709	Decubitus ulcer, other site
73010	Chronic osteomyelitis, site unspecified
73011	Chronic osteomyelitis involving shoulder region
73012	Chronic osteomyelitis involving upper arm
73013	Chronic osteomyelitis involving forearm
73014	Chronic osteomyelitis involving hand
73015	Chronic osteomyelitis involving pelvic region and thigh
73016	Chronic osteomyelitis involving lower leg
73017	Chronic osteomyelitis involving ankle and foot
73018	Chronic osteomyelitis involving other specified sites
73019	Chronic osteomyelitis involving multiple sites
7854	Gangrene
9064	Late effect of crushing
9065	Late effect of burn of eye, face, head, and neck
9066	Late effect of burn of wrist and hand
9067	Late effect of burn of other extremities
9068	Late effect of burns of other specified sites
9069	Late effect of burn of unspecified site
9092	Late effect of radiation
990	Effects of radiation, unspecified
99652	Mechanical complication of prosthetic graft of other tissue, not elsewhere classified
99660	Infection and inflammatory reaction due to unspecified device, implant, and graft
99661	Infection and inflammatory reaction due to cardiac device, implant, and graft
99662	Infection and inflammatory reaction due to other vascular device, implant, and graft

Physicians who bill for the professional component of HBOT should use procedure code 1-99183. Procedure code 1-99183 is limited to one per day.

Outpatient hospitals that bill for HBOT may be reimbursed with revenue code B-413. HBOT is limited to one initial and three subsequent therapies per day.