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Reimbursement/Payment/Utilization

Questions pertaining to Reimbursement, Payment, & Utilization

How much does Medicare spend on hyperbaric oxygen therapy (HBO2)?
Published: 10 August 2016

How much does Medicare spend on hyperbaric oxygen therapy (HBO2)?

Medicare Payment Amount by CPT/Outpatient APC Codes for Hyperbaric Services  CY2009-2015 (Millions of $'s)

     
                   
 

Professional Claims

               
 

Calendar Year

2009

2010

2011

2012

2013

2014

2015

 
 

99183

42

48

52

56

58

60

50

 
 

G0277

0

0

0

0

0

0

2

 
 

Total

42

48

52

56

58

60

52

 
                   
 

Outpatient Hospital Facility Claims

               
 

Calendar Year

2009

2010

2011

2012

2013

2014

2015

 
 

Outpatient Prospective Payment System

122

142

148

162

172

183

170

 
 

HCPC-(G0277,C1300) APC Code-0659

122

142

148

162

172

183

170

 
 

Non-Outpatient Prospective Payment System

3

4

6

6

8

9

7

 
 

99183

2

2

3

3

3

4

3

 
 

C1300

1

2

3

4

4

5

0

 
 

G0277

0

0

0

0

0

0

4

 
 

Total

125

146

154

169

180

192

178

 
                   
 

Note:

               
 

Medicare Claims Integrated Data Repository (IDR) received as of 5/31/2016 with claim "thru" dates between Calendar Years 2009 and 2015

 
 

Professional Claims were tabulated by HCPC for NCH Claim Types {71,72,81,82}, while Outpatient Claims were tabulated for NCH Claim Type 40.

 
 

In most cases, for years 2009-2015 the OPPS packages services for CPT code G0277 and C1300 under Ambulatory Procedure Code 0659.

 
 

A small amount of spending was billable by CAHs and Short Term Hospitals as unbundled services outside of the OPPS labeled as "Non-OPPS".

We (Wellspan Health) had previously asked UHMS to clarify the thinking around the ACLS requirement for a site. My understanding is that UHMS does not require us to have a Crash Cart but we must have chest tubes and an ACLS trained physician. Recently, I heard from a Compliance Manager at BMS that the CMS has started to crack down on sites with no Crash Cart. Do you have any similar information or can you offer any additional guidance?
Published: 29 December 2016

We (Wellspan Health) had previously asked UHMS to clarify the thinking around the ACLS requirement for a site. My understanding is that UHMS does not require us to have a Crash Cart but we must have chest tubes and an ACLS trained physician. Recently, I heard from a Compliance Manager at BMS that the CMS has started to crack down on sites with no Crash Cart. Do you have any similar information or can you offer any additional guidance?

This is partially true. Some physicians who are not ACLS and audited have had to pay back. In the latest version of the HBO2 Novitas LCD, there is still information requiring ACLS (please see attached document L32739).

We recommend reviewing all MAC policy on a semiannual basis at a minimum.