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December 2016 Texas Medicaid Provider Procedures Manual

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

4.2.13
HBOT is a type of therapy that increases the environmental oxygen pressure to promote the movement of oxygen from the environment into the client’s body tissues. Such treatment may be a benefit of Texas Medicaid when it is performed in specially constructed hyperbaric chambers, pressurized to 1.4 atmosphere absolute (atm abs) or higher, which may hold one or more clients (sea-level pressure is equal to 1 atm.abs). Although oxygen may be administered by mask, cannula, or tube in addition to the hyperbaric treatment, this use of oxygen is not considered hyperbaric oxygen treatment in itself.
HBOT procedure codes 99183 and G0277 require prior authorization before the date that service is initiated.
The number of billable units of procedure code G0277 is based upon the time that the client receives treatment with hyperbaric oxygen.
In calculating how many 30-minute intervals to report, hospitals should take into consideration the time spent under pressure during descent, air breaks, and ascent, (in minutes), as follows:
Procedure code 99183 equates to one total treatment (one professional session).
Procedure code G0277 must be billed with revenue code B-413 on the same claim. If procedure code G0277 is not on the same claim as revenue code B-413, the claim will be denied.
Refer to:
Subsection 9.2.33, “Hyperbaric Oxygen Therapy (HBOT),” in the Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook (Vol. 2, Provider Handbooks) for more information.

Texas Medicaid & Healthcare Partnership
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