Hyperbaric Oxygen Therapy (HBOT)

HBOT involves the therapeutic administration of 100% oxygen at environmental pressures > 1 atmosphere absolute (ATA), the atmospheric pressure at sea level. Administering oxygen at pressures greater than 1 ATA requires compression. This is achieved by placing the patient in an airtight chamber. The pressure is increased inside the chamber, and 100% oxygen is given for respiration, which delivers a greatly increased pressure of oxygen to the lungs, blood, and tissues.

This coverage decision concerns the use of HBOT for tissue damage only.  Therapy is usually provided for one to two hours under hyperbaric conditions, and patients typically require 10 to 60 therapy sessions. It is delivered in single person or multiple person chambers.

Coverage decision: Hyperbaric oxygen therapy is covered with conditions (Effective date: March 1, 2014).

Note: The insurer typically pays for HBOT for the following conditions resulting from a work-related incident: air or gas embolism, carbon monoxide poisoning and decompression sickness.

Authorization requirements


Is authorization required?

How do I get pre-authorization?

Yes

L&I (State fund):
Complete the Preauthorization Form and fax to (360) 902-4567

Self-insured:
Contact the employer or its third party administrator

 

Related rules

 

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