CPT® 99183; Physician or Other Qualified Healthcare Professional Attendance and Supervision of Hyperbaric Oxygen Therapy, per Session - JE Part B
CPT® 99183; Physician or Other Qualified Healthcare Professional Attendance and Supervision of Hyperbaric Oxygen Therapy, per Session
In order to fulfill its contractual obligation with CMS, Noridian Healthcare Solutions (Noridian), your Medicare Contractor, performs pre-payment reviews in accordance with CMS direction. CMS is required by the Social Security Act to ensure that payment is made only for those medical services that are reasonable and necessary. Medical review assesses submitted documentation to validate provider compliance with Medicare payment rules and regulations, including coverage, coding and billing guidelines.
This is to update providers of the claim review findings for CPT ® 99183, Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session. The results of this focused review are not a reflection on providers' competence as a health care professional or the quality of care provided to patients. Specifically, the results are based on the documentation requested by Medicare and/or your facility's compliance with the required documentation.
The Jurisdiction E, Part B Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of CPT ® 99183, Physician or other qualified health care professional attendance and supervision of hyperbaric oxygen therapy, per session. The quarterly edit effectiveness results from January 1, 2024, to March 31, 2024, are as follows:
Top Denial Reasons
- Failure to return records
- There is insufficient documentation of soft tissue radionecrosis.
- The documentation submitted was incomplete and/or insufficient.
Educational Resources
Education
The physician or other qualified health care provider attends and supervises hyperbaric oxygen therapy. Report per session. Report hyperbaric oxygen therapy procedures separately.
Coverage
The CMS HBO National Coverage Determination (NCD) 20.29 lists the indications and limitations of coverage.
HBO therapy is a valuable adjunctive treatment used in combination with accepted standard therapeutic measures when loss of function, limb, or life is threatened. HBO is indicated within the first 4-6 hours of the acute event, and only after documented restoration of the blood circulation. For reperfusion injuries, crush injuries or pending compartment syndrome, therapy beyond 2-3 days has not shown beneficial salvage or further limit to loss of tissue or limb.
Documentation must support no measurable sign of healing for 30 days prior to starting HBO including wound measurements prior to the initiation of HBO and wound measurements after HBO. Continued treatment with HBO therapy is not covered if measurable signs of healing have not been demonstrated within any 30-day period of treatment.
Noncovered Conditions
No program payment may be made for any conditions other than those listed in NCD 20.29 under A. Covered Conditions.
Documentation Requirements
Diabetic wound(s)
Wagner grade classification (must be Wagner grade III or higher) with diagnostic testing to support Wagner grade
Patient has type 1 or type 2 diabetes and has lower extremity wound due to diabetes
NCD does not cover surgical or injuries complicated by diabetes
Documentation supporting prior failed treatment using standard wound care
Documentation supporting there were no measurable signs of healing for at least 30 consecutive days of treatment when using standard wound therapy
Evaluation of wound at least every 30 days during administration of HBO therapy that supports evidence of measurable signs of healing
Standard Diabetic Wound Care Therapy Prior to Starting HBO
Assessment of patient's vascular status and correction of problems, if applicable
Support of optimization of nutritional status
Support of optimization of glucose control
Support of debridement of the devitalized tissue
Support of wound care management that includes maintenance of a clean, moist bed of granulated tissue with appropriate moist dressing
Support of appropriate off-loading
Support of treatment to resolve infection
The documentation submitted to a review entity should support the diagnosis used with HBO therapy. Clearly support wound measurements/assessments by providing documentation before and during HBO therapy.
Billing and Coding
Facility Services - UB-04 or electronic equivalent
| Type of Bill (TOB) | Revenue Code Applicable | HCPCS |
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Physician Services - CMS-1500 Claim Form
CPT 99183; Physician or other qualified health care professional attendance and supervision per session
MUE apply
Physician attendance and supervision of HBO therapy (CPT 99183) includes evaluation and management (E&M) services related to HBO therapy
Tips and Additional Information
Calculate total number of 30-minute intervals billable under HCPCS G0277
Time spent by patient under 100% oxygen
Time for descent
Time for air breaks and
Time for ascent
Additional units may be billed for sessions requiring at least 16 minutes of next 30-minute interval
Providers can appeal a denial if date of service exceeds five units. Documentation submitted must support units of service in excess were reasonable and necessary
Radionecrosis: Avoid denials. Send documentation to support diagnosis or to support that radiation therapy was at least six months prior to wound development
E&M services integral to HBO therapy include, but are not limited to, updating history and physical, examining patient, reviewing laboratory results and vital signs with special attention to pulmonary function, blood pressure, and blood sugar levels, clearing patient for procedure, monitoring and/or assisting with patient positioning, evaluating and treating patient for barotrauma and other complications, prescribing appropriate medications, etc.
Physician may report E&M services performed on same date of service of HBO with modifier 25, if a physician performs unrelated, significant, and separately identifiable services
Medicare coverage of topical oxygen for treatment of chronic wounds will be determined by local Medicare Administrative Contractors (MACs)
NCD lists non-covered items and services, such as cutaneous, decubitus, and stasis ulcers. Locate NCD for full list
