Medical Policy: 02.01.13 

Original Effective Date: September 1999 

Reviewed: March 2021 

Revised: March 2020 

 

Notice:

This policy contains information which is clinical in nature. The policy is not medical advice. The information in this policy is used by Wellmark to make determinations whether medical treatment is covered under the terms of a Wellmark member's health benefit plan. Physicians and other health care providers are responsible for medical advice and treatment. If you have specific health care needs, you should consult an appropriate health care professional. If you would like to request an accessible version of this document, please contact customer service at 800-524-9242.

 

Benefit Application:

Benefit determinations are based on the applicable contract language in effect at the time the services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary based on contract, and individual member benefits must be verified. Wellmark determines medical necessity only if the benefit exists and no contract exclusions are applicable. This medical policy may not apply to FEP. Benefits are determined by the Federal Employee Program.

 

This Medical Policy document describes the status of medical technology at the time the document was developed. Since that time, new technology may have emerged or new medical literature may have been published. This Medical Policy will be reviewed regularly and be updated as scientific and medical literature becomes available.

 

Description:

Hyperbaric oxygen therapy (HBOT) involves breathing 100% oxygen at pressures between 1.5 and 3.0 atmospheres. It is generally applied systemically with the patient inside a hyperbaric chamber. HBOT can also be applied topically i.e., the body part to be treated is isolated (e.g., in an inflatable bag and exposed to pure oxygen). HBOT has been investigated for various conditions that have potential to respond to increased oxygen delivery to tissue.

 

Systemic Hyperbaric Oxygen Therapy

In systemic or large hyperbaric oxygen chambers, the patient is entirely enclosed in a pressure chamber and breathes oxygen at a pressure greater than 1 atmosphere (the pressure of oxygen at sea level). Thus, this technique relies on systemic circulation to deliver highly oxygenated blood to the target site, typically a wound. Systemic HBOT can be used to treat systemic illness, such as air or gas embolism, carbon monoxide poisoning, or clostridial gas gangrene. Treatment may be carried out either in a monoplace chamber pressurized with pure oxygen or in a larger, multiplace chamber pressurized with compressed air, in which case the patient receives pure oxygen by mask, head tent, or endotracheal tube.

 

HBOT is a generally safe therapy, with an estimated adverse side effect rate of 0.4%. Adverse events may occur either from pressure effects or the oxygen. The pressure effect (barotrauma) may affect any closed air-filled cavity such as ears, sinus, teeth, and lungs. Pain and/or swelling may occur at these sites as pressure increases during the procedure and decreases as the procedure is ending. Oxygen toxicity may affect the pulmonary, neurologic, or ophthalmologic systems. Pulmonary symptoms include a mild cough, substernal burning, and dyspnea. Neurologic effects include tunnel vision, tinnitus, nausea, and dizziness. Ophthalmologic effects include retinopathy in neonates, cataract formation, and transient myopic vision changes.

 

Documentation regarding hyperbaric oxygen therapy (HBOT) should include the hyperbaric procedure logs with ascent time, descent time and pressurization level. In addition, there should be a treatment plan identifying timeline and treatment goals.

 

Clinical Context and Therapy Purpose

The purpose of systemic hyperbaric oxygen therapy (HBOT) is to provide a primary treatment modality while in others it is an adjuct to surgical or pharmacologi interventions that is an alternative or an improvement on existing therapies.

 

Patients

Patients with various conditions that have potential to respond to increased oxygen delivery to tissue.

 

Interventions

The therapy being considered is systemic hyperbaric oxygen therapy (HBOT).

 

Comparators

Comparators of interest include standard wound care and advanced wound therapy in the treatment of chronic diabetic ulcers. Standard wound care can include offloading of the wound with appropriate therapeutics, dressings, debridement antibiotic therapy, and blood glucose control. Advanced wound therapy can include the application of recombinant growth factors and wound coverage with heterogeneic dressings. Systemic HBOT may be used as an adjunct to these comparators. Patients with chronic diabetic ulcers are managed by surgeons, wound care specialists, podiatrists and primary care providers in a clinical setting.

 

Comparators of interest include breathing oxygen at standard pressure and other supportive measures such as a ventilator. Systemic HBOT may be used as an adjunct to these comparators. Patients with carbon monoxide poisoning are managed in the emergency care setting by emergency medicine physicians.

 

Comparators of interest include debridement and medication. Medications prescribed for radionecrosis may include corticosteroids and anticoagulants. For osteoradionecrosis, medications include vasodilators. Medication for the treatment of irradiated jaw can include antibiotics. Systemic HBOT may be used as an adjunct to these comparators. Patients with radionecrosis, osteoradionecrosis, and treatment of irradiated jaw are managed by radiation oncologists, orthopedic surgeons and oral maxillofacial surgeons potentially in both inpatient and outpatient clinical settings.

 

Comparators of interest include medication and surgical therapy. Medications prescribed may consist of systemic antibiotics and systemic or topical antifungals. Systemic HBOT may be used as an adjunct to these comparators. Patients with bisphosphonate-related osteonecrosis of the jaw are managed by surgeons, dentists, and oral maxillofacial surgeons in both inpatient and outpatient clinical settings.

 

Comparators of interest include medication and surgical therapy. Medications prescribed for chronic refractory osteomyelitis may include intravenous antibiotics. Surgery can include debridement. Systemic HBOT may be used as an adjunct to these comparators. Patients with chronic refractory osteomyelitis are managed by orthopedic surgeons, wound specialists, and primary care providers.

 

Comparators of interest include cooling therapy and medication. Medications prescribed for acute thermal burns may include antibiotics. Pain and anxiety medication may also be used. Systemic HBOT may be used as an adjunct to these comparators. Patients with acute thermal burns are managed by burn specialists and surgeons in an inpatient clinical setting.

 

Comparators of interest include dressings, debridement, and medication. Medications prescribed for acute surgical and traumatic wounds may include antibiotics and pain management. Systemic HBOT may be used as an adjunct to these comparators. Patients with acute surgical and traumatic wounds are actively managed by emergency care providers and surgeons in an inpatient clinical setting.

 

Comparators of interest include medication and surgical therapy. Medications prescribed for necrotizing soft tissue infection may include antibiotics. Surgical therapy can include debridement. Systemic HBOT may be used as an adjunct to these comparators. Patients

with necrotizing soft tissue infections are managed by surgeons, wound care specialists, and infectious disease specialists in an inpatient clinical setting.

 

Comparators of interest include medical therapy. Medications prescribed for idiopathic sudden sensorineural hearing loss (ISSNHL) may include systemic and intratympanic steroids, antiviral and hemodilution agents and, mineral, vitamin, and herbal supplements. Patients with ISSNHL are managed by otolaryngologists and primary care providers in an outpatient clinical setting.

 

Outcomes

The general outcomes of interest are overall survival (OS), symptoms, change in disease status and functional outcomes.

 

Summary of Evidence

Evidence in the published peer-reviewed medical literature and professional society guidelines to include the Undersea and Hyperbaric Medical Society (UHMS) support the safety and effectiveness as a primary treatment or adjunctive treatment for the indications listed below. The Undersea and Hyperbaric Medical Society guideline provides recommendations for indications where systemic hyperbaric oxygen therapy (HBOT) has been demonstrated to provide clinical benefits. For the majority of these indications there are adequate data to provide guidance regarding treatment duration, frequency and depth of pressurization. The evidence is sufficient to determine that systemic hyperbaric oxygen therapy (HBOT) results in a meaningful improvement in net health outcomes for the following indications listed below:

  • Decompression sickness
  • Acute carbon monoxide poisoning
  • Gas gangrene (i.e., clostridial myositis and myonecrosis)
  • Osteomyelitis, refractory to conventional medical and surgical management
  • Compromised skin grafts or flaps
  • Prophylactic pre-operative and post-operative treatment for patients undergoing dental surgery (non-implant-related) of an irradiated jaw
  • Chronic non-healing wounds
  • Profound/severe anemia with exceptional blood loss: only when blood transfusion is impossible or must be delayed
  • Acute cyanide poisoning
  • Air or gas embolism
  • Progressive necrotizing infections (necrotizing fasciitis)
  • Acute peripheral arterial insufficiency
  • Acute traumatic ischemia e.g., crush injuries, reperfusion injury, compartment syndrome
  • Actinomycosis, only when refractory to antibiotics and surgical treatment
  • Non-healing diabetic wounds of the lower extremities meeting all of the following criteria:
    • Type I or II diabetes mellitus
    • Wound classified as Wagner grade III or higher
    • History of failed standard wound therapy
  • Idiopathic sudden sensorineural hearing loss (defined as a hearing loss of at least 30dB occurring within 3 days over at least 3 contiguous frequencies) when treatment is initiated within 2 weeks of onset combined with steroid therapy; or as salvage therapy within 1 month of onset of SSNHL combined with steroid therapy
  • Central retinal artery obstruction when treatment is initiated within 24 hours of vision loss
  • Delayed radiation injuries (soft tissue and bony necrosis) (e.g., induced tissue injury, especially in gynecologic malignancies; cystitis, radiation enteritis,  proctitis & osteoradionecrosis)
  • Acute thermal burns deep second degree or third degree in nature
  • Intracranial abscess (i.e., cerebral abscess, subdural empyma, and epidural empyma

 

There is insufficient evidence in the published peer-reviewed medical literature to support the use of systemic hyperbaric oxygen therapy (HBOT) as a primary or adjuvant treatment of the conditions listed below. Further randomized controlled trials (RCTs) are needed to include double blind comparisons of HBOT to sham HBOT. The evidence is insufficient in determining the effects of the technology on net health outcomes.

  • Acute carbon tetrachloride poisoning
  • Acute cerebral edema
  • Acute coronary syndromes and as adjunct to coronary artery interventions including but not limited to percutaneous coronary interventions and cardiopulmonary bypass
  • Acute frost bite
  • Acute thermal burns (except as indicated above)
  • AIDS/HIV
  • Alzheimer’s disease
  • Asthma
  • Autism spectrum disorder (ASD)
  • Bell’s palsy
  • Bone graft
  • Brain injury, acute and traumatic brain injury (TBI)
  • Brown recluse spider bite (necrotizing arachnoidism)
  • Cerebral palsy
  • Cerebrovascular disease, acute (thrombotic or embolic) or chronic
  • Chronic arm lymphedema following radiotherapy for cancer
  • Crohn’s disease (includes fistulizing Crohn’s disease)
  • Demyelinating disease including but not limited to multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS)
  • Depression
  • Early treatment (beginning at the completion of radiation therapy) to reduce side effects of radiation therapy
  • Fracture healing
  • Heart disease
  • Hepatitis
  • Hydrogen sulfide poisoning
  • Idiopathic femoral head necrosis
  • Idiopathic sensorineural hearing loss (except as indicated above)
  • Intra-abdominal abscesses
  • In-vitro fertilization
  • Lepromatous leprosy
  • Meningitis
  • Migraine headaches/headaches
  • Motor dysfunction associated with stroke
  • Neurologic conditions
  • Parkinson’s disease
  • Preconditioning to improve myocardial function and/or reduce postoperative complications in patients undergoing coronary artery bypass grafting (CABG)
  • Pseudomembranous colitis (antimicrobial agent-induced colitis)
  • Pyoderma gangrenosum
  • Radiation induced injury of head and neck
  • Refractory mycoses (except for actinomycosis as indicated above)
  • Spinal cord injury
  • Sports injury
  • Tumor sensitization for cancer treatments including but not limited to radiotherapy or chemotherapy

 

The FDA issued a warning (2013; updated 2018) regarding the use of hyperbaric oxygen therapy (HBO) for indications that are not FDA approved (“off-label”). Per the FDA, the safety and effectiveness of HBO has not been established for the following diseases and conditions: AIDS/HIV, Alzheimer's disease, autism, asthma, Bell's palsy, brain Injury, cerebral palsy, depression, diabetes, heart disease, hepatitis, migraine, multiple sclerosis, Parkinson's disease, spinal cord injury, sport's injury, and stroke.

 

Topical Hyperbaric Oxygen Therapy or Topical Oxygen Therapies

There are two types of topical oxygen therapy (TOT), topical hyperbaric oxygen therapy (THOT) and continuous topical oxygen therapy (CTOT).

 

Topical hyperbaric oxygen therapy (THOT) is a technique of delivering 100% oxygen directly to an open, moist wound at a pressure slightly higher than atmospheric pressure. It is hypothesized that the high concentrations of oxygen diffuse directly into the wound to increase the local cellular oxygen tension, which in turn promotes wound healing. Devices consist of an appliance to enclose the wound area and a source of oxygen; conventional oxygen tanks may be used. The appliances may be disposable and may be used without supervision in the home by well-trained patients. Topical hyperbaric oxygen therapy (THOT) has been investigated as a treatment of wounds, burns, or infections. Topical oxygenation may be performed in the home or clinic and office setting. Typically, therapy is offered for 90 minutes per day for four consecutive days. After a three-day break, the cycle may be repeated.

 

Clinical Context and Therapy Purpose

The purpose of topical hyperbaric oxygen therapy (THOT) is to provide a treatment option that is an alternative or an improvement on existing therapies in treating wounds, burns or infections.

 

Patients

The relevant population of interest is individuals with wounds, burns, or infections.

 

Interventions

The therapy being considered is topical hyperbaric oxygen therapy (THOT). Patients with wounds, burns, or infections are actively managed by emergency care providers, dermatologists, wound care specialists, and primary care providers in a clinical setting.

 

Comparators

Comparators of interest include dressings, debridement, and medication. Medications prescribed may include topical antibiotics and antiseptics. Pain and anxiety management medication may also be used. Topical hyperbaric oxygen therapy (THOT) may be used as an adjunct to these comparators.

 

Outcomes

The general outcomes of interest are overall survival (OS), symptoms, change in disease status, and functional outcomes.

 

Based on the site and severity of the wound, burn, or infection, patients may require prolonged physical and occupational support to evaluate symptoms. Additionally, the existing evidence on the use of topical hyperbaric oxygen therapy involves studies that treat patients for 12 weeks, but information on follow-up was limited. Therefore, follow-up should be determined based on the site and severity of the wound, burn or infection and can range from months to a year after starting treatment.

 

Summary of Evidence

Based on review of the peer reviewed medical literature topical hyperbaric oxygen therapy (THOT) may be a promising treatment based on studies, but it cannot be recommended for routine clinical care at this time due to a restricted volume and quality of supporting scientific evidence. More investigation is necessary to determine if topical hyperbaric oxygen therapy (THOT) can be used in the clinical setting. Per the 2018 guidelines by the Undersea and Hyperbaric Medical Society for chronic wounds, the guidelines states "before topical oxygen therapy can be recommended for non-healing wounds, its application should be subjected to additional scientific scrutiny to better establish indications for use, dosing and response to treatment. Future clinical studies should address these issues." Further randomized controlled trials are warranted to examine the safety and effectiveness of this therapy. The evidence is insufficient in determining the effects of the technology on net health outcomes.

 

Continuous Topical Oxygen Therapy (CTOT)

Continuous topical oxygen therapy (CTOT) is a newer alternative to topical hyperbaric oxygen therapy (THOT) that does not require patient immobilization or in-clinic administration and can be used at the same time as dressings and offloading. A portable oxygen concentrator refines and delivers atmospheric (normobaric) oxygen to the wound site through a cannula, the end of the cannula (tube) is placed onto the wound site and is covered with an occlusive dressing or pressure dressing. The oxygen is delivered at a low flow rate so the wound will not dry out. Continuous topical oxygen therapy (TCOT) has been proposed in the treatment of skin ulcerations resulting from diabetes, venous stasis, post-surgical infections, gangrenous lesions, pressure ulcers/decubitus ulcers, infected residual limbs, skin grafts, burns and frostbite.

 

The goal of topical continuous oxygen therapy (TCOT) is to provide an uninterrupted and continuous supply of oxygen to a moist wound. The dressing is designed such that the oxygen is supplied in a manner that most closely approximates the normal diffusion of oxygen in moist tissues, yet a rate sufficient to fuel the increased oxygen demands required in healing tissues. With this therapy the dressing helps provide an environment for optimal wound healing while managing wound exudate levels, protecting against wound dehydration and protecting against external contamination. Contraindications to this wound therapy include wounds with inadequate perfusion to support healing; ulcers due to acute thrombophlebitis; ulcers due to Raynaud’s disease; necrotic wounds covered with eschar or slough; wounds with fistulae or deep sinus tracts with unknown depth.

 

The following are continuous topical oxygen therapy (CTOT) devices:

  • EPIFLO® Transdermal Continuous Oxygen Therapy (Ogenix) consists of a small, silent, disposable, oxygen concentrator and a long sterile cannula (tube). It is used with any fully occlusive sterile wound dressing to continuously blanket the wound with near 100% oxygen. The patient is free to ambulate and can continue with normal daily living activities while being treated 24 hours per day. EPIFLO® can be worn near the wound beneath clothing without impairing its operation.

EPIFLO® extracts oxygen from the air, concentrates it to near 100%, and “pumps” the oxygen through the cannula to blanket the wound. The wound is covered with a fully occlusive dressing of the doctor's choice. The dressing does not inflate and the patient has no sensation of air movement. EPIFLO® provides a silent, continuous, slow flow of oxygen (3 ml/hr for 15 days) that will not dry out the wound. Some clinicians suggest that EPIFLO® mimics the bloodstream in delivering the necessary metabolic energy to oxygen starved cells. EPIFLO® energizes ischemic cells to jump start the natural healing process. Oxygen helps form collagen, granulation tissue, new blood vessels and skin.

  • TransCu 02 Wound Care Device or EO2 System (EO2 Concepts) is a portable oxygen delivery system that provides a continuous flow of oxygen to a wound. Through a dressing attached to the device, oxygen is provided directly to the wound for 24 hours per day, 7 days a week. Oxygen is an important part in the wound healing process.

The EO2 System employs a TransCu 02 device which uses fuel cell technology to continuously generate pure humidified oxygen at adjustable flow rates from 3-15 ml/hr and delivers it directly to the wound bed environment within the OxySpur dressing. The OxySpur Oxygen Diffusion Dressing is an all-in-one dressing for medium to high exudating wounds. It’s design ensures even distribution of oxygen over the entire wound. 

 

Summary of Evidence

Based on review of the peer reviewed medical literature continuous topical oxygen therapy (CTOT) may be a promising treatment based on studies, but it cannot be recommended for routine clinical care at this time due to a restricted volume and quality of supporting scientific evidence. More investigation is necessary to determine if continuous topical oxygen therapy (CTOT) can be used in the clinical setting. Per the 2018 guidelines by the Undersea and Hyperbaric Medical Society for chronic wounds, the guidelines states "before topical oxygen therapy can be recommended for non-healing wounds, its application should be subjected to additional scientific scrutiny to better establish indications for use, dosing and response to treatment. Future clinical studies should address these issues." Further randomized controlled trials are warranted to examine the safety and effectiveness of this therapy. The evidence is insufficient in determining the effects of this technology on net health outcomes.

 

Practice Guidelines and Position Statements

American Academy of Otolaryngology-Head and Neck Surgery

In 2019, the American Academy of Otolaryngology – Head and Neck Surgery updated the clinical guideline on treatment of sudden hearing loss:

 

Statement 9a. Initial Therapy with Hyberbaric Oxygen Therapy: Clinicians may offer, or refer to a clinician who can offer, hyperbaric oxygen therapy (HBOT) combined with steroid therapy within 2 weeks of onset of sudden sensorineural hearing loss (SSNHL). Option based on systematic reviews of RCTs with a balance between benefit and harm.

 

Statement 9b. Salvage Therapy with Hyperbaric Oxygen Therapy: Clinicians may offer, or refer to a clinician who can offer, hyperbaric oxygen therapy (HBOT) combined with steroid therapy as salvage within 1 month of onset of sudden sensorineural hearing loss (SSNHL). Option based on systematic reviews of RCTs and new RCTs with a balance of benefit and harm.

 

Infectious Disease Society of America

In 2012, the Infectious Disease Society of America published a guideline on the diagnosis and treatment of diabetic foot infections. The guideline states: “No adjunctive therapy has been proven to improve resolution of infection, but for selected diabetic foot wounds that are slow to heal, clinicians might consider using hyperbaric oxygen therapy (strong, moderate).”

 

Hyperbaric oxygen therapy: A limited number of randomized controlled trials are available to support its use for wound healing (but not resolving infection).

 

Undersea & Hyperbaric Medical Society (UHMS)

In 2019, the Undersea and Hyperbaric Medical Society (UHMS) issued the 14th edition for hyperbaric oxygen therapy that included the following recommendations:

 

Indications for Hyperbaric Oxygen Therapy:

  • Air or gas embolism
  • Carbon monoxide poisoning and carbon monoxide poisoning complicated by cyanide poisoning
  • Clostridial myositis and myonecrosis (gas gangrene)
  • Crush injury, compartment syndrome and other acute traumatic ischemias
  • Decompression sickness
  • Arterial insufficiencies
    • Cranial retinal artery occlusion
    • Enhancement of healing in selected problem wounds
  • Severe anemia
  • Intracranial abscess
  • Necrotizing soft tissue infections
  • Osteomyelitis (refractory)
  • Delayed radiation injury (soft tissue and bony necrosis)
  • Compromised grafts and flaps
  • Acute thermal burn injury
  • Idiopathic sudden sensorineural hearing loss

 

In 2015, the Undersea and Hyperbaric Medical Society (UHMS) issued a clinical practice guideline for the use of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers, that included the following recommendations:

  • In patients with Wagner Grade 2 or lower diabetic foot ulcers, we suggest against using hyperbaric oxygen therapy (very low-level evidence in support of HBO2, conditional recommendation)
  • In patients with Wagner Grade 3 or higher diabetic foot ulcers that have not shown significant improvement after 30 days of treatment, we suggest adding hyperbaric oxygen therapy to the standard of care to reduce the risk of major amputation and incomplete healing (moderate-level evidence, conditional recommendation)
  • In patients with Wagner Grade 3 or higher diabetic foot ulcers who have just had surgical debridement of an infected foot (e.g. partial toe or ray amputation; debridement of ulcer with underlying bursa, cicatrix or bone; foot amputation; incision and drainage of deep space abscess; or necrotizing soft tissue infection), we suggest adding acute post-operative hyperbaric oxygen therapy to the standard of care to reduce the risk of major amputation and incomplete healing (moderate -level of evidence, conditional recommendation)

 

In 2009, the Undersea and Hyperbaric Medical Society (UHMS) issued a position paper on the treatment of autism spectrum disorder (ASD) with hyperbaric oxygen therapy which states: There are few data upon which to base firm conclusions regarding the use of hyperbaric oxygen therapy for the treatment of ASD. “At this time, the UHMS cannot recommend the routine treatment of ASD with hyperbaric oxygen therapy outside appropriate comparative research protocols.”

 

The Undersea and Hyperbaric Medical Society (UHMS) issued a position paper on the treatment of multiple sclerosis with hyperbaric oxygen therapy: The synthesis of data presented suggests there is little evidence for the efficacy of hyperbaric oxygen therapy from trials with a low potential for bias. Most randomized controlled trials have failed to show any clinical benefit, while a minority have suggested some benefit. “At this time, the UHMS cannot recommend the routine treatment of multiple sclerosis with hyperbaric oxygen therapy outside appropriate comparative research protocols.”

 

In 2018, the Undersea and Hyperbaric Medical Society (UHMS) updated their position statement on topical oxygen for chronic wounds which states: Topical oxygen may be a promising treatment based on some recent studies, but it cannot be recommended for routine clinical care at this time due to a restricted volume and quality of supporting scientific evidence. More investigation is necessary to determine if topical oxygen can be used in the clinical setting for wound care. In particular, we need better information on precise indications for use, optimal dosing regimens and standardized outcomes. Future clinical studies should address these issues.

 

Before topical oxygen therapy can be recommended for non-healing wounds, its application should be subjected to additional scientific scrutiny to better establish indications for use, dosing and response to treatment.

 

American College of Hyperbaric Medicine (ACHM)

In 2015, the following indications are approved by the American College of Hyperbaric Medicine and are reimbursable through CMS:

  • Air or gas embolism
  • Acute carbon monoxide intoxication
  • Clostridial myositis and myonecrosis (gas gangrene)
  • Crush injury, compartment syndrome and acute traumatic ischemias
  • Decompression illness
  • Enhancement of healing in select problem wounds
  • Extreme anemia
  • Intracranial abscess
  • Necrotizing soft tissue infections
  • Osteomyelitis (refractory)
  • Delayed radiation injury (soft tissue and bony necrosis)
  • Skin flaps and grafts (compromised)

 

If sufficient data demonstrates that hyperbaric oxygen therapy is associated with a favorable risk-benefit ratio for an indication, which is not currently on the approved list from the Centers of Medicare and Medicaid, The Undersea and Hyperbaric Medical Society or a Commercial Insurance Carrier, the ACHM will endorse the application of hyperbaric therapy for the supported indication. Indications that meet these criteria and are supported by the ACHM as appropriate for hyperbaric oxygen therapy include:

  • Acute thermal burns
  • Acute central retinal artery occlusion
  • Acute frost bite
  • Actinomycosis (refractory and recalcitrant)
  • Brown recluse spider bites
  • Idiopathic sudden sensorineural hearing loss

 

The ACHM supports the treatment of patients with non-approved indications only in a research setting using a protocol that has been approved by an Institutional Review Board. The ACHM supports the continued performance of well-designed clinical trials in these areas, especially those that are prospective, randomized, controlled trials. The ACHM does not support the treatment of non-approved conditions for financial gain, without investigational treatment protocols. College members who intentionally mislead the patient or family into believing that hyperbaric therapy is an approved indication or is supported by peer reviewed literate will be dismissed from the ACHM.

 

Tenth European Consensus Conference on Hyperbaric Medicine

In 2016, the tenth European Consensus Conference on Hyperbaric Medicine issued recommendations for accepted and non-accepted clinical indications of hyperbaric oxygen treatment that included the following:

 

Level of Evidence: Grade A = High level of evidence; Grade B = Moderate level of evidence; Grade C = Low level of evidence; Grade D = Very low level of evidence.

 

Strength of Recommendation: Level 1 = strong recommendation (we recommend); Level 2 = weak recommendation (we suggest); Level 3 = neutral recommendation (would be reasonable); no recommendation = no agreement was reached by the group of experts.

 

Condition Level of Evidence Strength of Recommendation
Carbon monoxide (CO) poisoning Moderate level of evidence Strong recommendation (we recommend)
Open fractures with crush injury Moderate level of evidence Strong recommendation (we recommend)
Prevention of osteoradionecrosis after dental extraction Moderate level of evidence Strong recommendation (we recommend)
Osteoradionecrosis (mandible) Moderate level of evidence Strong recommendation (we recommend)
Soft tissue radionecrosis (cystitis, proctitis) Moderate level of evidence Strong recommendation (we recommend)
Decompression illness Low level of evidence Strong recommendation (we recommend) 1
Gas embolism Low level of evidence Strong recommendation (we recommend)
Anerobic or mixed bacterial infections Low level of evidence Strong recommendation (we recommend)
Sudden deafness Moderate level of evidence Strong recommendation (we recommend)
Diabetic foot lesions Moderate level of evidence Weak recommendation (we suggest)
Femoral head necrosis Moderate level of evidence Weak recommendation (we suggest)
Compromised skin grafts and musculocutaneous flaps Low level of evidence Weak recommendation (we suggest)
Central retinal artery occlusion (CRAO) Low level of evidence Weak recommendation (we suggest)
Crush injury without fracture Low level of evidence Weak recommendation (we suggest)
Osteoradionecrosis (bones other than mandible) Low level of evidence Weak recommendation (we suggest)
Radio-induced lesions of soft tissues (other than cystitis and proctitis) Low level of evidence Weak recommendation (we suggest)
Surgery and implant in irradiated tissue (preventative treatment) Low level of evidence Weak recommendation (we suggest)
Ischaemic ulcers Low level of evidence Weak recommendation (we suggest)
Refractory chronic osteomyelitis Low level of evidence Weak recommendation (we suggest)
Burns 2nd degree more than 20% BSA Low level of evidence Weak recommendation (we suggest)
Pneumatosis cystoides intestinalis Low level of evidence Weak recommendation (we suggest)
Neuroblastoma, Stage IV Low level of evidence Weak recommendation (we suggest)
Brain injury (acute and chronic TBI, chronic stroke, post anoxic encephalopathy) in highly selected patients Low level of evidence Neutral recommendation (would be reasonable)
Radio-induced lesions of larynx Low level of evidence Neutral recommendation (would be reasonable)
Radio-induced lesions of the CNS Low level of evidence Neutral recommendation (would be reasonable)
Post-vascular procedure reperfusion syndrome
Limb replantation
Selected non-healing wounds secondary to systemic processes
Sickle cell disease Low level of evidence Neutral recommendation (would be reasonable)
Interstitial cystitis Low level of evidence Neutral recommendation (would be reasonable)

 

Society for Vascular Surgery in Collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine

In 2016, the Society for Vascular Surgery in Collaboration with the American Podiatric Medical Association and the Society for Vascular Medicine issued a clinical practice guideline for the management of diabetic foot. The guideline includes the following: “For diabetic foot ulcers (DFUs) that fail to demonstrate improvement (>50% wound area reduction) after a minimum of 4 weeks of standard wound therapy, the committee recommends adjunctive wound therapy options. These include negative pressure therapy, biologics (platelet-derived growth factor, living cellular therapy, extracellular matrix products, amniotic membrane products), and hyperbaric oxygen therapy. Choice of adjuvant therapy is based on clinical findings, availability of therapy, and cost-effectiveness; there is no recommendation on ordering of therapy choice. Re-evaluation of vascular status, infection control, and off-loading is recommended to ensure optimization before initiation of adjunctive wound therapy.” (Grade 1B)

 

The guideline also states: “In patients with diabetic foot ulcer (DFU) who have adequate perfusion that fails to respond to 4 to 6 weeks of conservative management, the committee suggests hyperbaric oxygen therapy.” (Grade 2B)

 

Prior Approval:

Not applicable

 

Policy:

Systemic Hyperbaric Oxygen Therapy (HBOT) (99183, G0277)

Systemic hyperbaric oxygen therapy (HBOT) is considered medically necessary in the treatment of the following conditions:

  • Decompression sickness
  • Acute carbon monoxide poisoning
  • Gas gangrene (i.e., clostridial myositis and myonecrosis)
  • Osteomyelitis, refractory to conventional medical and surgical management
  • Compromised skin grafts or flaps
  • Prophylactic pre-operative and post-operative treatment for patients undergoing dental surgery (non-implant-related) of an irradiated jaw
  • Chronic non-healing wounds
  • Profound/severe anemia with exceptional blood loss: only when blood transfusion is impossible or must be delayed
  • Acute cyanide poisoning
  • Air or gas embolism
  • Progressive necrotizing infections (necrotizing fascitis)
  • Acute peripheral arterial insufficiency
  • Acute traumatic ischemia e.g., crush injuries, reperfusion injury, compartment syndrome
  • Actinomycosis, only when refractory to antibiotics and surgical treatment
  • Non-healing diabetic wounds of the lower extremities meeting all of the following criteria:
    • Type I or II diabetes mellitus
    • Wound classification as Wagner grade III or higher
    • History of failed standard wound therapy as defined below
      • Initiation of HBO: Covered as adjunct therapy when at least 30 consecutive days of standard wound therapy alone has produced no measurable signs of healing. HBO therapy must be used in addition to standard diabetic wound care measures such as: assessment of vascular status; correction of vascular problems in the affected limb if possible; optimization of nutritional status; optimization of glucose control; debridement by means to remove devitalized tissue; maintenance of a clean moist bed of granuation tissue with appropriate moist dressings; appropriate off loading; and necessary treatment to resolve any infection that might be present. OR
      • Continued HBO: If the wound fails to show measurable signs of healing within 30 days of initiating systemic HBO therapy and at each 30- day interval of systemic HBO therapy, continued treatment with systemic HBO therapy is considered not medically necessary and, therefore, not covered.
  • Idiopathic sudden sensorineural hearing loss (SSNHL) (defined as a hearing loss of at least 30dB occurring within 3 days over at least 3 contiguous frequencies) when treatment is initiated within 2 weeks of onset combined with steroid therapy; or as a salvage therapy within 1 month of onset of SSNHL combined with steroid therapy
  • Central retinal artery obstruction when treatment is initiated within 24 hours of vision loss
  • Delayed radiation injuries (soft tissue and bony necrosis) (e.g., induced tissue injury, especially in gynecologic malignancies; cystitis, radiation enteritis, proctitis and osteoradionecrosis)
  • Acute thermal burns, deep second degree or third degree in nature
  • Intracranial abscess (i.e., ceregral abscess, subdural empyma, and epidural empyma) 

 

Systemic hyperbaric oxygen therapy (HBOT) is considered investigational for all other indications, including, but not limited to, the following:

  • Acute carbon tetrachloride poisoning
  • Acute cerebral edema
  • Acute coronary syndromes and as adjunct to coronary artery interventions including but not limited to percutaneous coronary interventions and cardiopulmonary bypass
  • Acute frost bite
  • Acute thermal burns (except as indicated above)
  • AIDS/HIV
  • Alzheimer’s disease
  • Asthma
  • Autism spectrum disorder (ASD)
  • Bell’s palsy
  • Bone graft
  • Brain injury, acute and traumatic brain injury (TBI)
  • Brown recluse spider bite (necrotizing arachnoidism)
  • Cerebral palsy
  • Cerebrovascular disease, acute (thrombotic or embolic) or chronic
  • Chronic arm lymphedema following radiotherapy for cancer
  • Crohn’s disease (includes fistulizing Crohn’s disease)
  • Demyelinating disease including but not limited to multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS)
  • Depression
  • Early treatment (beginning at the completion of radiation therapy) to reduce side effects of radiation therapy
  • Fracture healing
  • Heart disease
  • Hepatitis
  • Hydrogen sulfide poisoning
  • Idiopathic femoral head necrosis
  • Idiopathic sudden sensorineural hearing loss (except as indicated above)
  • Intra-abdominal abscesses
  • In-vitro fertilization
  • Lepromatous leprosy
  • Meningitis
  • Migraine headaches/headaches
  • Motor dysfunction associated with stroke
  • Neurologic conditions
  • Parkinson’s disease
  • Preconditioning to improve myocardial function and/or reduce postoperative complications in patients undergoing coronary artery bypass grafting (CABG)
  • Pseudomembranous colitis (antimicrobial agent-induced colitis)
  • Pyoderma gangrenosum
  • Radiation induced injury of head and neck
  • Refractory mycoses (except for actinomycosis as indicated above)
  • Spinal cord injury
  • Sports injury
  • Tumor sensitization for cancer treatments including but not limited to radiotherapy or chemotherapy

 

There is insufficient evidence in the published peer review medical literature to support the use of systemic hyperbaric oxygen therapy (HBOT) as a primary or adjuvant treatment of the conditions listed above. Further randomized controlled trials (RCTs) are needed to include double blind comparisons of hyperbaric oxygen therapy (HBOT) to sham hyperbaric oxygen therapy (HBOT). The evidence is insufficient in determining the effects of the technology on net health outcomes.

 

Topical Hyperbaric Oxygen Therapy (THOT) (A4575)

Topical hyperbaric oxygen therapy is considered investigational for all indications.

 

Based on review of the peer reviewed medical literature, topical hyperbaric oxygen therapy therapy (THOT) may be a promising treatment, but it cannot be recommended for routine clinical care at this time due to a restricted volume and quality of supporting scientific evidence. More investigation is necessary to determine if topical hyperbaric oxygen therapy (THOT) can be used in the clinical setting. Per the 2018 guidelines by the Undersea and Hyperbaric Medical Society for chronic wounds, the guidelines states "before topical oxygen therapy can be recommended for non-healing wounds, its application should be subjected to additional scientific scrutiny to better establish indications for use, dosing and response to treatment. Future clinical studies should address these issues." Further randomized controlled trials are warranted to examine the safety and effectiveness of this therapy. The evidence is insufficient in determining the effects of the technology on net health outcomes.

 

ContinuousTopical Oxygen Therapy (CTOT) (E0446)

Continuous topical oxygen therapy (CTOT), also known as transdermal continuous oxygen wound therapy or continuous diffusion oxygen (CDO) wound therapy, including but not limited to the following is considered investigational for all indications.

  • EPIFLO Transdermal Continuous Oxygen Therapy
  • TransCu 02 Wound Care Device or E02

 

Based on review of the peer reviewed medical literature continuous topical oxygen therapy (CTOT) may be a promising treatment, but it cannot be recommended for routine clinical care at this time due to a restricted volume and quality of supporting scientific evidence. More investigation is necessary to determine if continuous topical oxygen therapy (CTOT) can be used in the clinical setting. Per the 2018 guidelines by the Undersea and Hyperbaric Medical Society for chronic wounds, the guidelines states "before topical oxygen therapy can be recommended for non-healing wounds, its application should be subjected to additional scientific scrutiny to better establish indications for use, dosing and response to treatment. Future clinical studies should address these issues." Further randomized controlled trials are warranted to examine the safety and effectiveness of this therapy. The evidence is insufficient in determining the effects of this technology on net health outcomes.

 

Policy Guidelines

Wagner Grade Wound Classification

The Wagner classification system is used to assess wound parameters in individuals with diabetes, including the depth of penetration, the presence of osteomyelitis or gangrene, and the extent of tissue necrosis. The wound grades are defined as follows:

  • Grade 0 - No open lesion
  • Grade I - Superficial ulcer, not involving subcutaneous tissue
  • Grade II - Deep ulcer with penetration through the subcutaneous tissue potentially exposing tendon, bone, or joint capsule
  • Grade III - Deep ulcer penetrates deeper than Grade II and has evidence of abscess (pus) or osteomyelitis (bone infection)
  • Grade IV - Gangrene present in the toe(s)
  • Grade V - Gangrene of the foot requiring amputation

 

Definitions

Thermal Burn: The depth of the burn injury is related to contact temperature, duration of contact of the external heat source, and the thickness of the skin. Because the thermal conductivity of skin is low, most thermal burns involve the epidermis and part of the dermis. The most common thermal burns are associated with flames, hot liquid, hot solid objects and steam. The depth of the burn largely determines the healing potential and the need for surgical grafting.

 

Classification

The traditional classification of burns as first, second, third degree was replaced by a system reflecting the need for surgical intervention. The term fourth degree is still used to describe the most severe burns. The current designations of burn depth are classified as the following:

  • Superficial or epidermal (first degree): superficial or epidermal burns involve only the epidermal layer of skin.
  • Partial thickness (second degree): partial thickness burns involve the epidermis and portions of the dermis. They are characterized as either superficial or deep.
    • Superficial: These burns characteristically form blisters within 24 hours between the epidermis and dermis.
    • Deep: These burns extend into the deeper dermis and are characteristically different from superficial partial thickness burns. Deep burns damage hair follicles and glandular tissue.
  • Full thickness (third degree): these burns extend through and destroy all layers of the dermis and often injure the underlying subcutaneous tissues.
  • Fourth degree are deep and potentially life threatening injuries that extend through the skin into underlying tissues such as the fascia, muscle and/or bone.

 

Procedure Codes and Billing Guidelines:

To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or diagnosis codes.

  • 99183 Physician or other qualified health care professional, attendance and supervision of hyperbaric oxygen therapy, per session
  • A4575 Topical hyperbaric oxygen chamber, disposable
  • E0446 Topical oxygen delivery system, NOS, includes all supplies and accessories
  • G0277 Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval

 

Selected References:

  • Landau  Z. Topical hyperbaric oxygen and low energy laser for the treatment of diabetic foot ulcers. Archives of Orthopaedic and Trauma Surgery 1998;117:156-158
  • Leslie CA,  Sapico FL, Ginunas VJ, Adkins RH.  Randomized controlled trial of topical hyperbaric oxygen for treatment of diabetic foot ulcer. Diabetes Care 1988; 11:111-115. 
  • Colombel JF, Bouault JM, Lesage X, Zavadil P, Quandalle P, Cortot A. Hyperbaric oxygenation in severe perineal Crohn's disease. Diseases of the Colon and Rectum 1995; 38:609-614. 
  • Lambert PM, Intriere N, Eichstaedt R. Management of dental extractions in irradiated jaws: A protocol with hyperbaric oxygen therapy. Journal of Oral and Maxillofacial Surg 1997; 55:268-274. 
  • Sipahi AM, Damiao AOMC, de Sousa MM,  Barbutti RC,  Trivellato S,  Esteves C, D'Agostino M,  Laudanna AA. Hyperbaric Oxygen: A new alternative in the treatment of perianal Crohns disease. Revista do Hospital das Clinicas; Faculdade de Medicina de Universidade de Sao Paulo. 1996; 51(5):189-191.
  • Wilkerson R,  Paull W, Coville FV.  Necrotizing Fasciitis; review of the literature and case report. Clinical Orthopedics and related research March 1987;216: 187-192.
  • Bakker D. Selected Aerobic and Anaerobic Soft Tissue Infections. In E.P. Kindwall and H.T. Whelan ( eds.), Hyperbaric Medicine Practice (pp. 575-597) Flagstaff, AZ: Best Pub. Co.
  • Gordillo GM, Sen CK. Revisiting the essential role of oxygen in wound healing. Am J Surg. 186 (2003) 259-263. 
  • Sheikh AY, Gibson JJ, Rollins MD, Hopf HW, Hussain Z, Hunt TK. Effect of Hyperoxia on Vascular Endothelial Growth Factor Levels in a Wound Model. Arch Surg. 2000;135:1293-1297.
  • ECRI. Hyperbaric Oxygen Therapy for Brain Injury, Stroke, Multiple Sclerosis, Cerebral Palsy, and Autism. Plymouth Meeting (PA): ECRI 2008 January 8. 13p. (ECRI Hotline Response).
  • ECRI. Hyperbaric Oxygen Therapy for Chronic Wound Healing. Plymouth Meeting (PA): ECRI 2007 August 23. 11p. (ECRI Hotline Response).
  • ECRI. Hyperbaric Oxygen Therapy for Soft Tissue Radionecrosis. Plymouth Meeting (PA):ECRI 2008 January 8. 10p. (ECRI Hotline Response).
  • ECRI. Hyperbaric Oxygen Therapy for Hemorrhagic Cystitis. Plymouth Meeting (PA): ECRI 2007 September 20. 7p. (ECRI Hotline Response).
  • Rossignol DA, Rossignol LW, Smith S et al. Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind controlled trial. BMC Pediatrics 2009; 9:21.
  • Bennett M, Hart B. UHMS Position Paper Treatment of children with autism spectrum disorder with hyperbaric oxygen therapy. December 5, 2009.
  • Londahl M, Landin-Olsson M, Katzman P. Hyperbaric oxygen therapy improves health-related quality of life in patients with diabetes and chronic foot ulcer. Diabet Med. 2011 Feb;28(2):186-90. doi: 10.1111/j.1464-5491.2010.03185.x.
  • Londahl M, Katzman P, Hammarlund C et al. Relationship between ulcer healing after hyperbaric oxygen therapy and transcutaneous oximetry, toe blood pressure and ankle-brachial index in patients with diabetes and chronic foot ulcers. Diabetologia. 2001 Jan;54(1):65-8. Epub 2010 Oct 9.
  • Eskes A, Ubbink DT, Lubbers M et al. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds. Cochrane Database Syst Rev. 2010 Oct 6;(10):CD008059.
  • Spiegelberg L, Djasim UM, van Neck HW et al. Hyperbaric oxygen therapy in the management of radiation-induced injury in the head and neck region: a review of the literature. J Oral Maxillofac Surg. 2010 Aug;68(8):1732-9. Epub 2010 May 20.
  • Gothard L, Haviland J, Bryson P et al. Randomised phase II trial of hyperbaric oxygen therapy in patients with chronic arm lymphedema after radiotherapy for cancer. Radiother Oncol. 2010 Oct;97(1):101-7. Epub 2010 May 31.
  • Camporesi EM, Vezzani G, Bosco G et al. Hyperbaric oxygen therapy in femoral head necrosis. J Arthroplasty. 2010 Sep;25(6 Suppl):118-23. Epub 2010 Jul 15.
  • Cope A, Eggert JV, O'Brien E. Retinal artery occlusion: visual outcome after treatment with hyperbaric oxygen. Diving Hyperb Med. 2011 Sep; 41(3):135-8.
  • Butler FK Jr, Hagan C, Murphy-Lavoie H. Hyperbaric oxygen therapy and the eye. Undersea Hyperb Med. 2008 Sep-Oct; 35(5):333-87.
  • Menzel-Severing J, Siekmann U, Weinberger A et al. Early hyperbaric oxygen treatment for nonarteritic central retinal artery obstruction. Am J Ophthalmol. 2012 Mar; 153(3):454-59.e2. Epub 2011 Oct 11.
  • Stachler RJ, Chandrasekhar SS, Archer SM et al. Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg. 2012 Mar; 146(3 Suppl):S1-35.
  • Murphy-Lavoie H, Piper S, Moon RE et al. Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss. Undersea Hyperb Med 2012; 39(3):777-92.
  • Craighead P, Shea-Budgell MA, Nation J et al. Hyperbaric oxygen therapy for late radiation tissue injury in gynecologic malignancies. Curr Oncol. 2011 Oct; 18(5):220-7.
  • Allen S, Kilian C, Phelps J et al. The use of hyperbaric oxygen for treating delayed radiation injuries in gynecologic malignancies: a review of literature and report of radiation injury incidence. Support Care Cancer. 2012 Jan 14. [Epub ahead of print].
  • Bennett MH, Feldmeier J, Smee R et al. Hyperbaric oxygenation for tumor sensitization to radiotherapy. Cochrane Database Syst Rev. 2012 Apr 18; 4: CD005007.
  • Kranke P, Bennett MH, Martyn-St. James M et al. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2012 Apr 18; 4:CD004123.
  • Li Y, Dong H, Chen M et al. Preconditioning with repeated hyperbaric oxygen induces myocardial and cerebral protection in patients undergoing coronary artery bypass graft surgery: a prospective, randomized, controlled clinical trial. J Cardiothorac Vasc Anesth. 2011 Dec; 25(6):908-16. Epub 2011 Aug 25.
  • Jeysen ZY, Gerard L, levant G et al. Research report: the effects of hyperbaric oxygen preconditioning on myocardial biomarkers of cardioprotection in patients having coronary artery bypass graft surgery. Undersea Hyperb Med. 2011 May-Jun; 38(3):175-85.
  • Holland NJ, Bernstein JM, Hamilton JW. Hyperbaric oxygen for Bell's palsy. Cochrane Database Syst Rev 2012; 2:CD007288.
  • Feldmeier JJ, Hopf HW, Warriner III RA et al. UHMS position statement: topical oxygen for chronic wounds. Undersea Hyperb Med. 2005 May-Jun; 32(3): 157-68.
  • Bennett MH, Lehm JP, Jepson N. Hyperbaric oxygen therapy for acute coronary syndrome. Cochrane Database of Syst Rev. 2011; 8:CD004818.
  • Ghanizadeh A. Hyperbaric oxygen therapy for treatment of children with Autism: a systematic review of randomized trials. Med Gas Res 2012; 2:13.
  • Rossignol DA, Bradstreet JJ, Van Dyke K et al. Hyperbaric oxygen treatment in autism spectrum disorders. Med Gas Res 2012; 2(1):16. 
  • ECRI Institute: Windows on Medical Technology Policy Statement, Hyperbaric Oxygen Therapy for Chronic Wound Healing
  • ECRI Institute-Hyperbaric Oxygen Therapy for Chronic Wound Healing, published 04/01/2011
  • ECRI Institute-Topical Oxygen Therapy for Chronic Wound Healing, published 03/29/2011
  • Hypebaric oxygen therapy for Brain Injury, Stroke, Multiple Sclerosis, Cerebral Palsy and Autism, published 03/07/2011
  • Undersea and Hyperbaric Medical Society Hyperbaric Oxygen Therapy Indications 14th edition issued 2019
  • American College of Hyperbaric Medicine FAQ What are the Approved Indications for Hyperbaric Oxygen Therapy.
  • ECRI Institute: Transcutaneous Oxygen Monitoring for Managing Chronic Wounds, Published 02/05/2013
  • FDA Consumer Health Information. Hyperbaric Oxygen Therapy: Don’t be Mislead.
  • Centers for Medicare and Medicaid Services (CMS) National Coverage Determination (NCD) for Hyperbaric Oxygen Therapy (20.29).
  • Agency of Healthcare Research and Quality Evidence Report/Technology Assessment, Number 85, Hyperbaric Oxygen Therapy for Brain Injury, Cerebral Palsy and Stoke. AHRQ Pub. No. 03-E049 September 2003.
  • National Guideline Clearinghouse Clinical Practice Guideline: Sudden Hearing Loss. March 2012.
  • National Guideline Clearinghouse Traumatic Brain Injury Medical Treatment Guidelines. November 2012.
  • National Guideline Clearinghouse Guideline for Primary Care Management of Headache in Adults. July 2012.
  • National Guideline Clearinghouse Crohn’s Disease: Management in Adults, Children and Young People. NICE clinical guideline; no. 152, October 2012.
  • National Guideline Clearinghouse Management of Crohn’s Disease in Adults. Practice Parameters Committee of American College of Gastroenterology, Management of Crohn’s Disease in Adults. Am J Gastroenterol, 2009 Feb; 104(2):465, 484.
  • National Institute for Health and Care Excellence (NICE), Clinical Guideline 170. Autism, The Management and Support of Children and Young People on the Autism Spectrum. Issued August 2013.
  • Undersea and Hyperbaric Medical Society (UHMS) Position Statement: Topical Oxygen for Chronic Wounds. UHM 2005, Vol. 32, No. 3.
  • Transcutaneous Oximetry in Clinical Practice: Consensus Statements from an Expert Panel Based on Evidence. UHM 2009, Vol. 36, No. 1.
  • PubMed Hyperbaric Oxygen Therapy for Multiple Sclerosis
  • American Family Physicians, Evaluation and Treatment of Brown Recluse Spider Bites, Am Fam Physician 2005 Oct 1; 72(7):1372-1376
  • Leslie CA, Sapico FL, Ginunas VJ, et al. Randomized controlled trial of topical hyperbaric oxygen for treatment of diabetic foot ulcers. Diabetes Care. Feb 1988;11(2):111-115. PMID 3289861
  • Kranke P, Bennett MH, Martyn-St James M, et al. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2012;4:CD004123. PMID 22513920
  • O'Reilly D, Pasricha A, Campbell K, et al. Hyperbaric oxygen therapy for diabetic ulcers: systematic review and meta-analysis. Int J Technol Assess Health Care. Jul 2013;29(3):269-281. PMID 23863187
  • Eskes A, Vermeulen H, Lucas C, et al. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds. Cochrane Database Syst Rev. 2013;12:CD008059. PMID 24343585
  • Dauwe PB, Pulikkottil BJ, Lavery L, et al. Does hyperbaric oxygen therapy work in facilitating acute wound healing: a systematic review. Plast Reconstr Surg. Feb 2014;133(2):208e-215e. PMID 24469192
  • Buckley NA, Juurlink DN, Isbister G, et al. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev. 2011(4):CD002041. PMID 21491385
  • Esposito M, Grusovin MG, Patel S, et al. Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants. Cochrane Database Syst Rev. 2008(1):CD003603. PMID 18254025
  • Bennett MH, Feldmeier J, Hampson N, et al. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev. 2012;5:CD005005. PMID 22592699
  • Freiberger JJ, Padilla-Burgos R, McGraw T, et al. What is the role of hyperbaric oxygen in the management of bisphosphonate-related osteonecrosis of the jaw: a randomized controlled trial of hyperbaric oxygen as an adjunct to surgery and antibiotics. J Oral Maxillofac Surg. Jul 2012;70(7):1573-1583. PMID 22698292  
  • Chen CE, Ko JY, Fu TH, et al. Results of chronic osteomyelitis of the femur treated with hyperbaric oxygen: a preliminary report. Chang Gung Med J. Feb 2004;27(2):91-97. PMID 15095953
  • Chen CE, Shih ST, Fu TH, et al. Hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis: a preliminary report. Chang Gung Med J. Feb 2003;26(2):114-121. PMID 12718388
  • Bennett MH, Stanford RE, Turner R. Hyperbaric oxygen therapy for promoting fracture healing and treating fracture non-union. Cochrane Database Syst Rev. 2012;11:CD004712. PMID 23152225
  • Friedman HI, Fitzmaurice M, Lefaivre JF, et al. An evidence-based appraisal of the use of hyperbaric oxygen on flaps and grafts. Plast Reconstr Surg. Jun 2006;117(7 Suppl):175S-190S; discussion 191S-192S. PMID 16799386
  • Levett D, Bennett MH, Millar I. Adjunctive hyperbaric oxygen for necrotizing fasciitis. Cochrane Database Syst Rev. 2015;1:CD007937. PMID 25879088
  • Jallali N, Withey S, Butler PE. Hyperbaric oxygen as adjuvant therapy in the management of necrotizing fasciitis. Am J Surg. Apr 2005;189(4):462-466. PMID 15820462
  • George ME, Rueth NM, Skarda DE, et al. Hyperbaric oxygen does not improve outcome in patients with necrotizing soft tissue infection. Surg Infect (Larchmt). Feb 2009;10(1):21-28. PMID 18991520
  • Bennett MH, Lehm JP, Jepson N. Hyperbaric oxygen therapy for acute coronary syndrome. Cochrane Database Syst Rev. 2011(8):CD004818. PMID 21833950
  • Bennett MH, Weibel S, Wasiak J, et al. Hyperbaric oxygen therapy for acute ischaemic stroke. Cochrane Database Syst Rev. 2014;11:CD004954. PMID 25387992
  • Efrati S, Fishlev G, Bechor Y, et al. Hyperbaric oxygen induces late neuroplasticity in post stroke patients--randomized, prospective trial. PLoS One. 2013;8(1):e53716. PMID 23335971
  • Holland NJ, Bernstein JM, Hamilton JW. Hyperbaric oxygen therapy for Bell's palsy. Cochrane Database Syst Rev. 2012;2:CD007288. PMID 22336830
  • Bennett MH, Trytko B, Jonker B. Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injury. Cochrane Database Syst Rev. 2012;12:CD004609. PMID 23235612
  • Wolf G, Cifu D, Baugh L, et al. The effect of hyperbaric oxygen on symptoms after mild traumatic brain injury. J Neurotrauma. Nov 20 2012;29(17):2606-2612. PMID 23031217
  • Cifu DX, Walker WC, West SL, et al. Hyperbaric oxygen for blast-related postconcussion syndrome: three-month outcomes. Ann Neurol. Feb 2014;75(2):277-286. PMID 24255008
  • Miller RS, Weaver LK, Bahraini N, et al. Effects of hyperbaric oxygen on symptoms and quality of life among service members with persistent postconcussion symptoms: a randomized clinical trial. JAMA Intern Med. Jan 2015;175(1):43-52. PMID 25401463
  • Marois P, Mukherjee A, Ballaz L. Hyperbaric Oxygen Treatment for Persistent Postconcussion Symptoms-A Placebo Effect? JAMA Intern Med. Jul 1 2015;175(7):1239-1240. PMID 26146912
  • Dulai PS, Gleeson MW, Taylor D, et al. Systematic review: The safety and efficacy of hyperbaric oxygen therapy for inflammatory bowel disease. Aliment Pharmacol Ther. Jun 2014;39(11):1266-1275. PMID 24738651
  • Pagoldh M, Hultgren E, Arnell P, et al. Hyperbaric oxygen therapy does not improve the effects of standardized treatment in a severe attack of ulcerative colitis: a prospective randomized study. Scand J Gastroenterol. Sep 2013;48(9):1033-1040. PMID 23879825
  • Murphy-Lavoie H, Piper S, Moon RE, et al. Hyperbaric oxygen therapy for idiopathic sudden sensorineural hearing loss. Undersea Hyperb Med. May-Jun 2012;39(3):777-792. PMID 22670557
  • Bennett MH, Kertesz T, Perleth M, et al. Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus. Cochrane Database Syst Rev. 2012;10: CD004739. PMID 23076907
  • Cvorovic L, Jovanovic MB, Milutinovic Z, et al. Randomized prospective trial of hyperbaric oxygen therapy and intratympanic steroid injection as salvage treatment of sudden sensorineural hearing loss. Otol Neurotol. Aug 2013;34(6):1021-1026. PMID 23820795
  • Bennett M, Feldmeier J, Smee R, et al. Hyperbaric oxygenation for tumour sensitisation to radiotherapy. Cochrane Database Syst Rev. 2005(4):CD005007. PMID 16235387
  • Van Voorhis BJ, Greensmith JE, Dokras A, et al. Hyperbaric oxygen and ovarian follicular stimulation for in vitro fertilization: a pilot study. Fertil Steril. Jan 2005;83(1):226-228. PMID 15652917
  • Bennett M, Best TM, Babul S, et al. Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury. Cochrane Database Syst Rev. 2005(4):CD004713. PMID 16235376
  • Ghanizadeh A. Hyperbaric oxygen therapy for treatment of children with autism: a systematic review of randomized trials. Med Gas Res. 2012;2:13. PMID 22577817
  • Rossignol DA, Rossignol LW, Smith S, et al. Hyperbaric treatment for children with autism: a multicenter, randomized, double-blind, controlled trial. BMC Pediatr. 2009;9:21. PMID 19284641
  • Sampanthavivat M, Singkhwa W, Chaiyakul T, et al. Hyperbaric oxygen in the treatment of childhood autism: a randomised controlled trial. Diving Hyperb Med. Sep 2012;42(3):128-133. PMID 22987458
  • Steele J, Matos LA, Lopez EA, et al. A Phase I safety study of hyperbaric oxygen therapy for amyotrophic lateral sclerosis. Amyotroph Lateral Scler Other Motor Neuron Disord. Dec 2004;5(4):250-254. PMID 15799556
  • Lacey DJ, Stolfi A, Pilati LE. Effects of hyperbaric oxygen on motor function in children with cerebral palsy. Ann Neurol. Nov 2012;72(5):695-703. PMID 23071074
  • Collet JP, Vanasse M, Marois P, et al. Hyperbaric oxygen for children with cerebral palsy: a randomized multicentre trial. HBO-CP Research Group. Lancet. Feb 24 2001;357(9256):582-586. PMID 11558483
  • Xiao Y, Wang J, Jiang S, et al. Hyperbaric oxygen therapy for vascular dementia. Cochrane Database Syst Rev.2012;7:CD009425. PMID 22786527
  • Spiegelberg L, Djasim UM, van Neck HW, et al. Hyperbaric oxygen therapy in the management of radiationinduced injury in the head and neck region: a review of the literature. J Oral Maxillofac Surg. Aug 2010;68(8):1732-1739. PMID 20493616
  • Camporesi EM, Vezzani G, Bosco G, et al. Hyperbaric oxygen therapy in femoral head necrosis. J Arthroplasty. Sep 2010;25(6 Suppl):118-123. PMID 20637561
  • Bennett MH, French C, Schnabel A, et al. Normobaric and hyperbaric oxygen therapy for migraine and cluster headache. Cochrane Database Syst Rev. 2008(3):CD005219. PMID 18646121
  • Peng Z, Wang S, Huang X, et al. Effect of hyperbaric oxygen therapy on patients with herpes zoster. Undersea Hyperb Med. Nov-Dec 2012;39(6):1083-1087. PMID 23342765
  • Yildiz S, Kiralp MZ, Akin A, et al. A new treatment modality for fibromyalgia syndrome: hyperbaric oxygen therapy. J Int Med Res. May-Jun 2004;32(3):263-267. PMID 15174219
  • Efrati S, Golan H, Bechor Y, et al. Hyperbaric oxygen therapy can diminish fibromyalgia syndrome – prospective clinical trial. PLoS One. 2015;10(5):e0127012. PMID 26010952
  • Hyperbaric Oxygen Therapy for Adults with Mental Illness: A Review of the Clinical Effectiveness. Ottawa ON: 2014 Canadian Agency for Drugs and Technologies in Health; 2014.
  • Bennett M, Heard R. Hyperbaric oxygen therapy for multiple sclerosis. Cochrane Database Syst Rev.2004(1):CD003057. PMID 14974004
  • Huang ET et al. A Clinical Practive Guideline for the Use of Hyperbaric Oxygen Therapy in the Treatment of Diabetic Foot Ulcers 2015; . Accessed July 1, 2015.
  • American Academy of Otolaryngology-Head and Neck Surgery Clinical practice guideline: sudden hearing loss. 2012; Accessed June 8, 2015.
  • UpToDate Hyperbaric Oxygen Therapy. C Crawford Mechem M.D., FACEP, Scott Manaker M.D., PhD. Topic last updated February 20, 2018.
  • UpToDate Smoke Inhalation. Jess Mandel M.D. Topic last updated December 8, 2014.
  • UpToDate. Carbon Monoxide Poisoning. Peter F Clardy M. D., Scott Manaker M.D., PhD, Holly Perry, M.D. Topic last updated June 6, 2018.
  • UpToDate Complications of SCUBA Diving. Dipak Chandy M.D., Gerald L Weinhouse M.D., Topic last updated October 19, 2017.
  • UpToDate Basic Principles of Wound Management. David G Armstrong DPM, M.D., PhD, Andrew J Meyr DPM. Topic last updated May 11, 2015.
  • UpToDate Necrotizing Soft Tissue Infections. Dennis L Stevens M.D. PhD, Larry M Baddour M.D., FIDSA. Topic last updated December 11, 2014.
  • Bennett MH, Stanford RE, Turner R. Hyperbaric oxygen therapy for promoting fracture healing and treating fracture non-union. Cochrane Database Syst Rev 2012 Nov 14:11 CD004712. PMID 23152225
  • Buckley NA, Juurlink DN, Isbister G, et. al. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database Syst Rev 2011 Apr 13:(4): CD002041. PMID 21491385
  • Eskes A, Vermeulen H, Lucas C. et. al. Hyperbaric oxygen therapy for treating acute surgical and traumatic wounds. Cochrane Database Syst Rev 2013 Dec 16:12: CD08059. PMID 24343585
  • Holland NJ, Bernstein JM, Hamilton JW. Hyperbaric oxygen therapy for Bell’s plasy. Cochrane Database Syst Rev. 2012 Feb 15:2: CD007288. PMID 22336830
  • Levett D, Bennett MH, Millar I. Adjunctive hyperbaric oxygen for necrotizing fasciitis. Cochrane Database Syst Rev. 2015 Jan 15:1 CD007937. PMID 25879088
  • Winfeld B. Topical oxygen and hyperbaric oxygen therapy use and healing rates in diabetic foot ulcers. Wounds 2014;26(5):E39-E47
  • Hingorani A, LaMuraglia GM, Henke P, et. la. The management of diabetic foot: A clinical practice guideline by the Society for Vascular Surgery in collaboration with the American Podiatric Medical Association and the Society of Vascular Medicine. J Vasc Surg 2016 Feb;63(2 Suppl):3S-21S. PMID 26804367
  • UpToDate. Investigational Therapies for Treatment Symptoms of Lower Extremity Peripheral Artery Disease. Emile R. Mohler III M.D. Topic last updated July 6, 2016.
  • UpToDate. Air Embolism. Liz C. O-Dowd M.D., Mark A. Kelly M.D., MACP. Topic last updated Feburary 5, 2019.
  • UpToDate. Management of Late Complications of Head and Neck Cancer and its Treatment. Thomas Galloway M.D., Robert J. Amdur M.D. Topic last updated May 7, 2018.
  • UpToDate. Management of Diabetic Foot Ulcers. David G. Armstrong DPM, M.D., PhD, Richard J de Asla M.D., David K. McCulloch M.D. Topic last updated February 5, 2019.
  • Kranke P, Bennett MH, Martyn-St James M, et. al. Hyperbaric Oxygen Therapy for Chronic Wounds. Cochrane Database Syst Rev 2015 Jun 24;(6):CD004123. PMID 26106870
  • Elraiyah T. Tsapas A, Prutsky G, et. al. A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. J Vasc Surg 2016 Feb;63(2 Suppl):46S-58S. PMID 26804368
  • Bennett MH, Feldmeier J, Hampson NB, et. al. Hyperbaric Oxygen Therapy for Late Radiation Tissue Injury. Cochrane Database Syst Rev 2016 Apr 28:4:CD005005. PMID 2713955
  • Wang F, Wang Y, Sun T, Yu HL. Hyperbaric oxygen therapy for the treatment of traumatic brain injury: a meta-analysis. Neurol Sci 2016 May;37(5):693-701. PMID 26746238
  • Crawford C, Teo L, Yang E. et. al. Is hyperbaric oxygen therapy effective for traumatic brain injury? A rapid evidence assessment of the literature and recommendations for the field. J Head Trauma Rehabil 2016 Sep 6. PMID 27603765
  • Xiong T, Chen H, Luo R, et. al. Hyperbaric oxygen therapy for people with autism spectrum disorder (ASD). Cochran Database Syst Rev. 2016 Oct 13. CD010922. PMID 27737490
  • Bennett MH, French C, Schnable A. et. al. Nomobaric and hyperbaric oxygen therapy for the treatment and prevention of migraine and cluster headache. Cochrane Database Syst Rev 2015 Dec 28;(12): CD005219. PMID 26709672
  • Huang ET, Feldmeier J, LeDex K, et. al. A clinical practice guideline for the use of hyperbaric oxygen therapy in the treatment of diabetic foot ulcers. Undersea Hyperb Med 2015 May-Jun;42(3):205-47
  • Mathieu D. Marroni A, Kot J. Tenth European Censensus  Conference on Hyperbaric Medicine: Recommendations for Accepted and Non-Accepted Clinical Indications and Practice of Hyperbaric Oxygen Treatment. Diving and Hyperbaric Medicine Volume 47 No. 1 March 2017
  • Sadri RA, Cooper JS, Hyperbaric, Complications. NCBI Bookshelf 2017.
  • de Smet GHJ, Kroese LF, Menon AG, et.al. Oxygen therapies and their effects on wound healing. Wound Repair Regen. Aug 2017;25(4):591-608. PMID 28783878
  • Borab Z, Mirmanesh MD, Gantz M, et al. Systematic review of hyperbaric oxygen therapy for the treatment of radiation-induced skin necrosis. J Plast Reconstr Aesthet Surg. Apr 2017;70(4):529-538. PMID 28081957
  • Ravi P, Vaishnavi D, Gnanam A, et al. The role of hyperbaric oxygen therapy in the prevention and management of radiation-induced complications of the head and neck - a systematic review of literature. J Stomatol Oral Maxillofac Surg. Dec 2017;118(6):359-362. PMID 28838774
  • Bennett MH, Lehm JP, Jepson N. Hyperbaric oxygen therapy for acute coronary syndrome. Cochrane Database Syst Rev. Jul 23 2015(7):CD004818. PMID 26202854
  • Sultan A, Hanna GJ, Margalit DN, et. al. The use of hyperbaric oxygen for the prevention and management of osteoradionecrosis of the jaw: a Dana-Farber/Brigham and Women’s Cancer Center Multidisciplinary Guideline. Oncologist Mar 2017;22(3):343-350. PMID 28209748
  • UpToDate. Basic Principles of Wound Management. David G. Armstrong DPM, MD, PhD, Adrew J Meyer DPM. Topic last updated December 4, 2017.
  • UpToDate. Clinical Staging and Management of Pressure Induced Skin and Tissue Injury. Dan Berlowitz MD, MPH. Topic last updated April 17, 2017.
  • Banks PG, Ho CH. A novel topical oxygen treatment for chronic and difficult to heal wounds: case studies. J Spinal Cord Med 2008;31(3):297-301. PMID 18795480
  • Bakri MH, Nagem H, Sessler DI, et. al. Transdermal oxygen does not improve sternal wound oxygenation in patients recovering from cardiac surgery. Anesth Analg 2008 June;106(6):1619-26. PMID 18499588
  • Schreml S, Szeimies RM, Prantl L, et. al. Oxygen in acute and chronic wound healing. Br J Dermatol 2010 Aug;163(2):257-68. PMID 20394633
  • Blackman E, Moore C, Hyatt J, et. al. Topical wound oxygen therapy in the treatment of severe diabetic foot ulcers: a prospective controlled trial. Ostomy Wound Manage 2010 Jun;56(6):24-31. PMID 20567051
  • Woo K, Coutts P, Sibbald G, et. al. Continuous topical oxygen for the treatment of chronic wounds: A pilot study. Advances in Skin and Wound Care December 2012 Volume 25 Issue 12 p 543-547
  • Hirsh F, Berlin SJ, Holtz A. Transdermal oxygen delivery to diabetic wounds: a report of 6 cases. Adv Skin Wound Care 2009 Jan;22(1):20-4. PMID 19096280
  • Gordillo GM, Sen CK. Evidence based recommendations for the use of topical oxygen therapy in the treatment of lower extremity wounds. Int J Low Extrem Wounds 2009 Jun:8(2):105-11. PMID 19443899
  • Sen CK. Wound healing essentials: let there be oxygen. Wound Repair Regen 2009 Jan-Feb;17(1):1-18. PMID 19152646
  • Howard MA, Asmis R, Evans KK, et. al. Oxygen and wound care: a review of current therapeutic modalities and future direction. Wound Repair Regen 2013 Jul-Aug;21(4):503-11. PMID 2376299
  • Driver VR, Yao M, Kantarci A, et. al. A prospective randomized clinical study evaluating the effect of transdermal oxygen therapy on biological processes and foot ulcer healing in persons with diabetes mellitus. Ostomy Wound Manage 2013 Nov;59(11):1-26. PMID 24201169
  • Yu J, Lu S, McLaren AM, et. al. Topical oxygen therapy results in complete wound healing in diabetic foot ulcers. Wound Repari Regen 2016 Nov2496);1066-1072. PMID 27733020
  • Brannick B, Engelthaler M, Jadzak J, et. al. A closer look at continuous diffusion of oxygen therapy for a chronic, painful venous leg ulcer. Podiatry Today Volume 27 Issue 11 November 2014
  • Couture M. Does continuous diffusion of oxygen have potential in chronic diabetic foot ulcers? Podiatry Today Vol. 28 Issue 12 December 2015
  • Niederauer M, Michalek J, Armstrong D. A prospective, randomized, double-blind multicenter study comparing continuous diffusion of oxygen therapy to sham therapy in the treatment of diabetic foot ulcers. Wound Med 2015;8:19-23
  • Sarangapani S, Mayer PV, Hoffman D. Transdermal Continuous Oxygen Therapy (TCOT) using EIPFLO. A new tool for wound healing. Journal of Wound Technology No 9 July 2010]
  • Lowell D, Nicklas B, Weily W, et. al. Transdermal continuous oxygen therapy as an adjunct for treatment of recalcitrant and painful wounds. The Foot and Ankle Journal 2(9): 4 2009
  • EPIFLO.
  • TransCu 02 Wound Care Device.
  • Rhee TM, Hwang D, Lee JS, et al. Addition of Hyperbaric Oxygen Therapy vs Medical Therapy Alone for Idiopathic Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. Sep 27 2018. PMID 3026703342. 
  • Cvorovic L, Jovanovic MB, Milutinovic Z, et al. Randomized prospective trial of hyperbaric oxygen therapy and intratympanic steroid injection as salvage treatment of sudden sensorineural hearing loss. Otol Neurotol. Aug 2013;34(6):1021-1026. PMID 23820795
  • Sun H, Qiu X, Hu J, et al. Comparison of intratympanic dexamethasone therapy and hyperbaric oxygen therapy for the salvage treatment of refractory high-frequency sudden sensorineural hearing loss. Am J Otolaryngol. Sep - Oct 2018;39(5):531-535. PMID 29891394
  • Almosnino G, Holm JR, Schwartz SR, et al. The Role of Hyperbaric Oxygen as Salvage Therapy for Sudden Sensorineural Hearing Loss. Ann Otol Rhinol Laryngol. Oct 2018;127(10):672-676. PMID 30009614
  • Xie S, Qiang Q, Mei L, et al. Multivariate analysis of prognostic factors for idiopathic sudden sensorineural hearing loss treated with adjuvant hyperbaric oxygen therapy. Eur Arch Otorhinolaryngol. Jan 2018;275(1):47-51. PMID 29071444
  • Long Y, Tan J, Nie Y, et al. Hyperbaric oxygen therapy is safe and effective for the treatment of sleep disorders in children with cerebral palsy. Neurol Res. Mar 2017;39(3):239-247. PMID 28079475      
  • Bennett M, Heard R. Hyperbaric oxygen therapy for multiple sclerosis. CNS Neurosci Ther. Apr 2010;16(2):115-124. PMID 20415839      
  • Lipsky BA, Berendt AR, Cornia PB, et al. 2012 infectious diseases society of america clinical practice guideline for the diagnosis and treatment of diabetic foot infections. J Am Podiatr Med Assoc. Jan-Feb 2013;103(1):2-7. PMID 23328846 
  • Centers for Medicare and Medicaid Services (CMS). National Coverage Determination (NCD) for Hyperbaric Oxygen Therapy (20.29). 2006; 
  • UpToDate. Overview of Treatment of Chronic Wounds. Karen Evans M.D., Paul Kim DPM, MS. Topic last updated June 20, 2017. 
  • UpToDate. Osteomyelitis in Adults: Treatment. Douglas R. Osmon M.D., Aaron J. Tande M.D., Topic last updated February 14, 2019. 
  • UpToDate. Autism Spectrum Disorder in Children and Adolescents: Complementary and Alternative Therapies. Laura  Weissman M.D., Carolyn Bridgemohan M.D., Topic last updated August 23, 2016. 
  • UpToDate. Frostbite. Ken Zafren M.D., FAAEM, FACEP, FAWM, C. Crawford Mechem M.D., FACEP., Topic last updated November 21, 2018. 
  • UpToDate. Sudden Sensorineural Hearing Loss. Peter W. Weber M.D., FACS. Topic last updated February 15, 2019. 
  • UpToDate. Clinical Manifestations, Diagnosis, and Treatment of Radiation Proctitis. Lawrence S. Friedman M.D., Topic last updated May 22, 2018. 
  • Shapshak D, Kelly M Publications Committee and the UHMS BOD Title: UHMS Position Statement: Topical Oxygen for Chronic Wounds Abstract issued 2018
  • Chandrasekhar S, Tsai Do B, Schwartz S, et. al, Clinical Practice Guideline: Sudden Hearing Loss (Update). Otolaryngology – Head and Neck Surgery 2019 Vol. 161 (IS) S1-S45

 

Policy History:

  • March 2021 - Annual Review, Policy Renewed
  • March 2020 - Annual Review, Policy Revised
  • March 2019 - Annual Review, Policy Revised
  • March 2018 - Annual Review, Policy Revised
  • March 2017 - Annual Review, Policy Revised
  • March 2016 - Annual Review, Policy Revised
  • April 2015 - Annual Review, Policy Revised
  • May 2014 - Annual Review, Policy Revised
  • July 2013 - Annual Review, Policy Revised
  • August 2012 - Annual Review, Policy Revised
  • August 2011 - Annual Review, Policy Revised

Wellmark medical policies address the complex issue of technology assessment of new and emerging treatments, devices, drugs, etc.   They are developed to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. Wellmark medical policies contain only a partial, general description of plan or program benefits and do not constitute a contract. Wellmark does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Wellmark or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. Our medical policies may be updated and therefore are subject to change without notice.

 

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