Before initiating hyperbaric oxygen (HBO) therapy, providers should ensure the medical record supports coverage under NCD 20.29 and clearly demonstrates medical necessity. Documentation should identify the covered indication being treated and support HBO as an adjunct to standard medical care. A physician order alone is not sufficient to establish coverage.

• For diabetic lower extremity wounds, the medical record should support:
• Type 1 or Type 2 diabetes mellitus
• Lower extremity ulcer classified as Wagner Grade III or higher

At least 30 days of standard wound therapy in which the wound has failed to demonstrate measurable healingDocumentation of standard wound care should include, as applicable:

• Debridement
• Infection management
• Off-loading
• Vascular assessment and treatment
• Moist wound care
• Optimization of glycemic control and nutrition

Objective wound assessment is critical to support both initial and continued medical necessity. The medical record should contain baseline wound characteristics and serial measurements throughout treatment, including:

• Wound size and depth at baseline and follow-up
• Wound evaluations at least every 30 days, including reassessment at least every 30 days to support continued treatment
• Evidence of measurable healing or clinical improvement

Continued HBO therapy requires documentation supporting ongoing medical necessity and clinical benefit. Records should include physician assessments, treatment goals, periodic reassessments, and progress notes demonstrating the patient's response to treatment.

Prior to claim submission, providers should confirm the documentation clearly supports:

1. A covered indication under NCD 20.29
2. Failure of appropriate standard therapy, when required
3. Medical necessity for both initiation and continuation of HBO therapy

Complete and well-documented medical records help support Medicare coverage and reduce the risk of claim denials.