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2012 Texas Medicaid Provider Procedures Manual

Inpatient and Outpatient Hospital Services Handbook : 4. Outpatient Hospital (Medical/Surgical Acute Care Outpatient Facility) : 4.2 Services, Benefits, Limitations, and Prior Authorization : 4.2.13 Hyperbaric Oxygen Therapy (HBOT)

4.2.13
Hyperbaric Oxygen Therapy (HBOT)
HBOT 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.
Authorization is not required. HBOT is diagnosis-restricted and is limited to one session per day.
Outpatient hospital clinics and freestanding facilities must use revenue code 413 to submit claims for the technical component. Revenue code 413 is limited to one session per day, per client, by any provider. HBOT is not payable to psychiatric hospitals.
Refer to:
Subsection 8.2.33, “Hyperbaric Oxygen Therapy (HBOT),” in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks).

Texas Medicaid & Healthcare Partnership
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