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Hyperbaric Oxygen Therapy (HBO) Services - Provider Reimbursement in Compliance with Federal Regulations

Hyperbaric oxygen (HBO) therapy involves giving a beneficiary high concentrations of oxygen within a pressurized chamber in which the beneficiary intermittently breathes 100 percent oxygen. HBO therapy is primarily an adjunctive treatment for the management of select nonhealing wounds. In accordance with Centers for Medicare & Medicaid Services Publication 100-03, National Coverage Determinations Manual, Ch. 20, § 20.29(A), a beneficiary must meet 1 of 15 covered conditions for providers to receive HBO reimbursement. Prior OIG reviews expressed concerns that: (1) beneficiaries received treatments for noncovered conditions, (2) medical documentation did not adequately support HBO treatments, and (3) beneficiaries received more treatments than were considered medically necessary. We will determine whether Medicare payments related to HBO outpatient claims were reimbursed in accordance with Federal requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Nov-16 Centers for Medicare & Medicaid Services Hyperbaric Oxygen Therapy (HBO) Services - Provider Reimbursement in Compliance with Federal Regulations Office of Audit Services W-00-16-35780; various reviews 2018

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