The Physician's Guide to HBOT Referral

The clearest referrals are the FDA-recognized indications: chronic diabetic lower-extremity wounds (Wagner III+ unresponsive to 30 days of standard care), delayed radiation injury, refractory osteomyelitis, compromised grafts/flaps, sudden sensorineural hearing loss (time-sensitive), and the emergency indications. Off-label requests should be framed honestly with the patient about evidence and self-pay. Our referral tool assesses indication strength and drafts a letter.

Medicare's NCD 20.29 governs coverage; most commercial payers follow it with prior authorization. The core codes are CPT 99183 (physician attendance) and HCPCS G0277 (per 30-minute interval). Denials usually reflect documentation gaps, not eligibility — the failed-standard-care record is the common sticking point. See the billing center.

A good hyperbaric clinic confirms the indication, screens contraindications, handles authorization, and reports progress back to you after each treatment block — you keep the patient relationship. Expect honest pushback on cases where HBOT won't help. Printable evidence digests support your prior authorizations.