Last Modified: 9/23/2020
Business: Part A
HBO is a modality in which the entire body is exposed to oxygen under increased atmospheric pressure. The patient is entirely enclosed in a pressure chamber breathing 100% oxygen (O2) at greater than one atmosphere (atm) pressure. Providers may use a mono-place chamber pressurized with pure O2, or a larger multi-place chamber pressurized with compressed air where the patient receives pure O2 by mask, head tent, or endotracheal tube.
For providers that received claim denials for HBO services and subsequently appealed the decision to First Coast, we often received insufficient medical record documentation that failed to support the medical necessity of the HBO therapy. The unfavorable redeterminations often lacked the following documentation:
• Complete history and physical
• Progress notes
• Order for the service
• Advance beneficiary notice (ABN)
• HBO treatment record to support the service was medically necessary and rendered as billed
Local Coverage Determination (LCD) L36504 Hyperbaric Oxygen Therapy
outlines the indications and limitations that must be documented in the medical record to support the medical necessity of these services.
Medical documentation must include:
• An initial assessment, which includes a history and physical that clearly substantiates the condition for which HBO is recommended.
• Procedure logs including ascent time, descent time, and pressurization level for the dates of service billed.
• Initial treatment plan for HBO therapy identifying the timeline and treatment goals.
• For continued HBO therapy, there must be documented evidence of effectiveness to meet the definition of a medically necessary treatment.
All other indications not specified under the regulations in the LCD or NCD are not covered under the Medicare program. No program payment may be made for HBO in the treatment of any conditions other than those identified.
Proper documentation takes time, but it can help you avoid spending valuable administrative hours filing appeals if your documentation is thorough and complete the first time.
For additional guidance when providing documentation for review, or filing an appeal, you may refer to our HBO documentation checklist
on our First Coast provider website.
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