Hyperbaric Oxygen (HBO) Therapy Services Documentation Requirements
It is expected that patient's medical records reflect the need for care/services provided. The listing of records is not all inclusive. Providers must ensure all necessary records are submitted to support services rendered. They may include:
Legible handwritten physician and/or clinician signatures
Valid electronic physician and/or clinician signatures
Physician or Non-Physician Practitioner (NPP) order for date of service, if applicable
Initial HBO evaluation/consultation by the physician or NPP
Documentation supporting HBO covered condition(s) for National Coverage Determination (NCD) for Hyperbaric Oxygen Therapy (20.29)
This is not an all-inclusive list
HBO Treatment plan
HBO dive logs/treatment records
Wound treatment records or wound flow sheets supporting measurable signs of healing
Diabetic wound(s) required documentation:
Standard diabetic wound care therapy documentation required prior to starting HBO:
Evaluation and Management (E&M) documentation, if billed on same date of service under medical review
Itemization of services
Advance Beneficiary Notice of Noncoverage (ABN), if applicable
Multiple CMS contractors are charged with completing reviews of medical records. See Identifying Which Entity Completed a Part A Claim Review for detailed information about each of these contractors.
Once a provider compiles all the necessary documentation, it is important to submit them to the appropriate contractor according to the request received. Select the request below to view the appropriate submission instructions.
- Noridian Medical Review: Additional Documentation Request (ADR)
- Comprehensive Error Rate Testing (CERT): CID Request
- Level One Appeal: Redetermination Request
View the Outpatient Prospective Payment System (OPPS) webpage for additional information and resources.
Last Updated Feb 08, 2019
Documentation Requirements Disclaimer
The documentation requirements contents/references provided within this section were prepared as educational tools and are not intended to grant rights or impose obligations. Use of these documents are not intended to take the place of either written law or regulations.
The listing of records is not all inclusive. Providers must ensure all necessary records are submitted to support services rendered.
Important that physician intent, physician decision and physician recommendation to provide services derived clearly from the medical record and properly authenticated.
The submission of these records shall not guarantee payment as all applicable coverage requirements must be met.