Indications and Protocols

Indications & Protocols

Indications for HBOT accepted and currently covered by Medicare

The Diabetic wounds of the lower extremity protocol listed below

is a sample of the protocols that we utilize in our

Wound Care and Hyperbaric Medicine Centers.

We provide additional protocols to our contracted hospitals.



Diagnosis: Diabetic Wounds of the Lower Extremities Medicare coverage available on or after April 1, 2003.

Coverage available for patients who meet the following criteria:

  1. Patient has Type I or Type II diabetes and has a lower extremity wound that is due to diabetes;

  2. Patient has a wound classified as Wagner grade III or higher; and

  3. Patient has failed an adequate course of standard wound therapy.

HBO is covered as adjunctive therapy only after there are no measurable signs of healing following at least 30 days of standard wound therapy.

ICD 9 Code:

250.7, 250.8, 707, 707.1, 707.10, 707.12, 707.13, 707.14, 707.19 or compatible ICD 10 Code

Wound Care Compliance Support
Wound Care Compliance Support

Clinical Data and/or Diagnostic reports needed to justify HBO therapy:

Proof that patient has undergone at least 30 days of standard wound therapy prior to initial HBO treatment and that subsequent HBO treatments are in conjunction with standard wound care.

Standard wound care in patients with diabetic wounds includes: assessment of a patient's vascular status and correction of any vascular problems in the affected limb if possible, optimization of nutritional status, optimization of glucose control, debridement by any means to remove devitalized tissue, maintenance of clean, moist bed of grandulation tissue with appropriate moist dressings, appropriate off-loading, and necessary treatment to resolve any infection that might be present.

Proof that the wounds have been evaluated every 30 days during administration of HBO therapy.

Tissue biopsy for polymicrobial infection in diabetic patients.

Documentation of undermining in diabetic patients.

Palpate for pulses or Doppler assessment.

Medical/surgical procedures required prior to, or in conjunction with, HBO therapy:

See Clinical Data and/or Diagnostic reports section above.

HBO treatment protocol:

2.0 ATA - 2.5 ATA for a duration of 90-120 minutes.
Once or twice per day.

Utilization Review:

Required after 30 days of HBO treatments.

Continued treatment with HBO is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment.

Wound Care Compliance Support

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