The Centers for Medicare & Medicaid Services (CMS) has embraced the concept of a site neutral payment structure which has allowed physicians and other mid-level providers to leave their hospital-based wound care practice in order to pursue an office based wound care model. This approach has given physicians more financial control, and subsequent rewards, while gaining greater flexibility in scheduling hours, increased independence, and control over their own professional future.
Much of the office based wound care model growth as come about as a result of an aging population and changing demographics. It is now estimated that there are upwards of 6 million non-healing wounds per year in the United States which cost approximately $25 billion annually. Most wounds are either venous, diabetic, arterial, pressure, or surgical in etiology. The lack of wound healing frequently involves local reasons, such as infection, inadequate offloading, poor circulation, or inadequate oxygenation. Other factors, such as age, nutrition, diabetes, obesity, smoking, and medications may also play contributing roles. These changes, and growing statistics, have led some 10,000 physicians into the practice of wound care. Of those, it is estimated that family physicians and internists make up approximately 35% of the providers.
Additionally, Medicare changes that took place in 2015 has contributed to the growth of office based wound care programs. The 2015 changes allowed for hyperbaric oxygen therapy to be billed for in site neutral locations, such as a physician’s private practice. At that time, CMS deleted HCPCS code C1300 the previous code for Hyperbaric oxygen under pressure and replaced it with HCPCS code G0277 Hyperbaric oxygen under pressure, full-body chamber, per 30-minute interval, which became effective Jan. 1, 2015. Unlike code C1300, which was only used in hospital-based outpatient departments (HOPDs) and ambulatory surgery centers (ASCs), code G0277 can be used in either a HOPD, ASC, or a physician’s private practice when hyperbaric oxygen therapy (HBOT) is provided on the premises. Subsequent to the 2015 change, physicians who have hyperbaric chambers in their offices may now bill for both their HBOT
attendance and supervision (CPT code 99183), and each 30-minute interval of HBOT (HCPCS code G0277) provided to the patient.
Office based wound care and hyperbaric clinics are one of the fastest growing segments of the
hyperbaric market. HBOT Is frequently used to treat diabetic wounds, radiation tissue damage (soft-tissue and osteoradionecrosis), osteomyelitis (Refractory), skin grafts and flaps (Compromised), necrotizing soft tissue infections and other medical indications. Did you know that with as little as 400 square feet physicians can add a hyperbaric oxygen chamber(s) to their practice? They will also need additional clinical space for wound care exam/treatment rooms. And finally, your office based wound care and HBO clinic will also require a high-pressure oxygen system, fire suppression system and hyperbaric training for staff and physicians.
If you would like to learn more about initiating a wound treatment program within your medical
practice, please contact Shared Health Services by emailing us at email@example.com or calling us at 1.800.474.0202.