Procedural Coding
• 99183 – Physician attendance and supervision of hyperbaric oxygen therapy, per session.
• C1300 – Hyperbaric oxygen under pressure, full body chamber, per 30-minute interval.
NOTE: Code C1300 is not available for use other than in a hospital outpatient department. In skilled nursing facilities (SNFs), HBO therapy is part of the SNF PPS payment for beneficiaries in covered Part A stays.
Billing Requirements for HBO Therapy for the Treatment of Diabetic Wounds of the Lower Extremities
Hyperbaric Oxygen Therapy is a modality in which the entire body is exposed to oxygen under increased atmospheric pressure.
Effective April 1, 2003, a National Coverage Decision expanded the use of HBO therapy to include coverage for the treatment of diabetic wounds of the lower extremities. For specific coverage criteria for HBO Therapy, refer to the National Coverage Determinations Manual, Chapter 1, section 20.29.
NOTE: Topical application of oxygen does not meet the definition of HBO therapy as stated above. Also, its clinical efficacy has not been established. Therefore, no Medicare reimbursement may be made for the topical application of oxygen.
Claims for HBO therapy should be submitted using the ASC X12 837 institutional claim format or, in rare cases, on Form CMS-1450.
Medicare will cover hyperbaric oxygen therapy only in the setting of a hospital, either inpatient or outpatient.
- Should a complication occur during HBO, a cardiopulmonary resuscitation team must be available to respond and provide Advanced Cardiac Life Support (ACLS). Personal physician supervision is often necessary for the scope of work required, and therefore, the immediate availability of an ACLS team is necessary during the hours that the hyperbaric chamber is in operation.
- Since the potential need for the availability of ICU-level of care services, it is reasonable and necessary to expect and require that HBO be provided only in an inpatient or outpatient hospital setting.
The CMS encourages physicians who perform HBO therapy to obtain adequate training in the use of HBO therapy and in advanced cardiac life support. It is also reasonable and necessary to expect the hospital that provides the setting for the delivery of HBO complete the process of credentialing. This would require that the attending physician provide documentation supporting that he is credentialed in hyperbaric medicine and is qualified to manage the scope of work required in the delivery of hyperbaric oxygen therapy, as well as being able to manage an acute cardiopulmonary emergency.
- Limited license physicians performing hyperbaric medicine services must have an unlimited license physician who is also credentialed in hyperbaric medicine by the hospital entity readily available to render assistance if needed.
- Medicare reimbursement will be limited to therapy that is administered in a chamber (including the one-man unit).
The following conditions meet coverage indications per National Coverage Determination (NCD) 20.29:
Covered Conditions
- Acute carbon monoxide intoxication (ICD-9-CM diagnosis code 986):
Acute carbon monoxide intoxication induces hypoxic stress. The cardiac and central nervous systems are the most susceptible to injury from carbon monoxide. The administration of supplemental oxygen is essential treatment. Hyperbaric oxygen causes a higher rate of dissociation of carbon monoxide from hemoglobin than can occur breathing pure air at sea level pressure. The chamber compressions should be between 2.5 and 3.0 atm. It is not uncommon in patients with persistent neurological dysfunction to require subsequent treatments within six to eight hours, continuing once or twice daily until there is no further improvement in cognitive functioning. This is an emergent condition requiring the continuous presence of the physician beside the chamber.
- Decompression illness (ICD-9-CM diagnosis codes 993.2 and 993.3):
Decompression illness arises from the formation of gas bubbles in tissue or blood in volumes sufficient enough to interfere with the function of an organ or to cause alteration in sensation. The cause of this enucleated gas is rapid decompression during ascent. The clinical manifestations range from skin eruptions to shock and death. The circulating gas emboli may be heard with a Doppler device. Treatment of choice for decompression illness is HB02 with mixed gases. The result is immediate reduction in the volume of bubbles. The treatment prescription is highly variable and case-specific. The depths could range between 60 to 165 feet of seawater for durations of 1.5 to more than 14 hours. The patient may or may not require repeat dives. This is an emergent condition requiring the continuous presence of the physician beside the chamber.
- Gas embolism (ICD-9-CM diagnosis codes 958.0 and 999.1):
Gas embolism occurs when gases enter the venous or arterial vasculature embolizing in a large enough volume to compromise the function of an organ or body part. This occlusive process results in ischemia to the affected areas. Air embolism may occur as a result of surgical procedures (e.g., cardiovascular surgery, infra-aortic balloons, arthroplasties or endoscopies), use of monitoring devices (e.g., Swan-Ganz introducer, infusion pumps) in non-surgical patients (e.g., ruptured lung in respirator-dependent patient, injection of fluids into tissue space) or traumatic injuries (e.g., gunshot wound, penetrating chest injuries). In these cases, HBO therapy may be the treatment of choice. It is most effective when initiated early. Therapy is directed toward reducing the volume of gas bubbles and increasing the diffusion gradient of the embolized gas. Treatment modalities range from high-pressure to low-pressure mixed gas dives. This is an emergent condition requiring the continuous presence of the physician beside the chamber.
- Gas gangrene (ICD-9-CM diagnosis code 040.0):
Gas gangrene is an infection caused by the clostridium bacillus, the most common being clostridium perfringens. Clostridial myositis and myonecrosis (gas gangrene) is an acute, rapidly growing invasive infection of the muscle. It is characterized by profound toxemia, extensive edema, massive death of tissue and a variable degree of gas production. The most prevalent toxin is the alpha-toxin which in itself is hemolytic, tissue-necrotizing and lethal. The diagnosis of gas gangrene is based on clinical data supported by a positive (Gram-stained) smear obtained from tissue fluids; X-ray radiographs, if obtained, can visualize tissue gas.
The onset of gangrene can occur one to six hours after injury and presents with severe and sudden pain at the infected area. The skin overlying the wound progresses from shiny and tense to dusky, then bronze in color. The infection can progress as rapidly as six inches per hour. Hemorrhagic vesicles may be noted. A thin, sweet-odored exudate is present. Swelling and edema occur. The non-contractile muscles progress to dark red to black in color.
The acute problem in gas gangrene is stopping the rapidly advancing infection caused by alpha-toxin and to continue treatment until the advancement of the disease process has been arrested. The goal of HBO therapy is to stop alpha-toxin production, thereby inhibiting further bacterial growth at which point the body can use its own host defense mechanisms. HBO treatment starts as soon as the clinical picture presents and is supported by a positive Gram-stained smear. A treatment approach utilizing HBO is an adjunct to antibiotic therapy and surgery. Initial surgery may be limited to opening the wound. Debridement of necrotic tissue can be performed between HBO treatments when clear demarcation between dead and viable tissue is evident. The usual treatment consists of oxygen administered at 3.0 atm pressure for 90 minutes, three times in the first 24 hours. Over the next four to five days, treatment sessions twice a day are usual. The sooner HBO treatment is initiated, the better the outcome is in terms of life, limb and tissue saving. This is an emergent condition requiring the continuous presence of the physician beside the chamber.
- Acute Traumatic Peripheral Ischemia (ATPI) (ICD-9-CM diagnosis codes 902.53, 903.1, 903.01 904.0 and 904.41):
HBO therapy is a valuable adjunctive treatment to be used in combination with accepted standard therapeutic measures when loss of function, limb or life is threatened.
- Crush injuries and suturing of severed limbs (ICD-9-CM diagnosis codes 927.00–927.03, 927.09–927.11, 927.20–927.21, 927.8–927.9, 928.00–928.01, 928.10–928.11, 928.20–928.21, 928.3, 928.8–928.9, 929.0, 929.9, and 996.90–996.96, 996.99):
As in the previous condition, HBO therapy would be an adjunctive treatment when loss of function, limb or life is threatened.
Acute traumatic ischemia is the result of injury by external force or violence compromising circulation to an extremity. The extremity is then at risk for necrosis or amputation. Secondary complications are frequently seen: infection, non-healing wounds and non-united fractures. The goal of HBO therapy is to enhance oxygen at the tissue level to support viability. When tissue oxygen tensions fall below 30 mmHg, the body’s ability to respond to infection and wound repair is compromised. Using HBO at 2–2.4 atm, the tissue oxygen tension is raised to such a level that the body’s responses can become functional again. The benefits of HBO for this indication are enhanced tissue oxygenation, edema reduction and increased oxygen delivery per unit of blood flow, thereby reducing the complication rates for infection, non-union and amputation.
The usual treatment schedule is three 1.5-hour treatment periods daily for the first 48 hours. Additionally, two 1.5-hour treatment sessions daily for the next 48 hours may be required. On the fifth and sixth days of treatment, one 1.5-hour session would typically be used. At this point in treatment, outcomes of restored perfusion, edema reduction and either demarcation or recovery would be sufficient to guide discontinuing further treatments.
For acute traumatic peripheral ischemic, crush injuries and suturing of severed limbs, HBO therapy is a valuable adjunctive treatment to be used in combination with accepted standard therapeutic measures when loss of function, limb or life is threatened. This is an emergent condition requiring the continuous presence of the physician beside the chamber.
- Progressive necrotizing infections (necrotizing fasciitis) (ICD-9-CM diagnosis code 728.86):
The principal treatment for progressive necrotizing infections is surgical debridement and systemic antibiotics. HBO is recommended as an adjunct only in those settings where mortality and morbidity are expected to be high despite aggressive standard treatment of the necrotizing infections. This condition is a relatively rare infection. It is usually a result of a group A streptococcal infection beginning with severe or extensive cellulitis that spreads to involve the superficial and deep fascia, producing thrombosis of the subcutaneous vessels and gangrene of the underlying tissues. A cutaneous lesion usually serves as a portal of entry for the infection, but sometimes no such lesion is found. This is an emergent condition requiring the continuous presence of the physician beside the chamber.
- Acute Peripheral Arterial Insufficiency (ICD-9-CM diagnosis codes 444.21, 444.22 and 444.81):
Acute peripheral arterial insufficiency is defined as the sudden occlusion of a major artery in an extremity such as the femoral or brachial artery (e.g., saddle embolus). Emergent surgery is the treatment of choice. The goal of HBO therapy is to enhance oxygen at the tissue level to support viability until a definitive procedure can be performed (e.g., surgery). Using HBO at 2–2.4 atm, the tissue oxygen tension is raised to such a level that the body’s responses can become functional again. The benefits of HBO for this indication are enhanced tissue oxygenation, edema reduction and increased oxygen delivery per unit of blood flow, thereby enhancing limb preservation. This is an emergent condition requiring the continuous presence of the physician beside the chamber.
- Preparation and preservation of compromised skin grafts (ICD-9-CM diagnosis code 996.52; excludes artificial skin):
HBO is utilized for graft or flap salvage in cases where hypoxia or decreased perfusion has compromised viability of an existing skin graft. HBO enhances flap survival. Treatments are given at a pressure of 2.0 to 2.5 atm lasting from 90–120 minutes. It is not unusual to receive treatments twice a day. When the graft or flap appears stable, treatments are reduced to daily. Medicare coverage does not apply to the initial preparation of the body site for a graft. HBO therapy is not necessary for normal, uncompromised skin grafts or flaps or for primary management of wounds.
- Chronic refractory osteomyelitis, unresponsive to conventional medical and surgical management (ICD-9-CM diagnosis codes 730.10–730.19):
HBO is an adjunctive therapy for chronic refractory osteomyelitis that persists or recurs following treatment with primary or first-line interventions. Primary/first-line interventions include antibiotics, aspiration of the abscess, immobilization of the affected extremity and surgery. The hallmarks of chronic refractory osteomyelitis include a nidus of infected dead bone or scar tissue, an ischemic soft tissue envelope and a refractory clinical course (defined as failure after standard surgical debridement and at least six weeks of appropriate antibiotic therapy). HBO is not to be used alone but as an adjunctive therapy in combination with antibiotics. Antibiotics are chosen on the basis of bone culture and sensitivity studies. HBO can elevate the oxygen tensions found in infected bone to normal or above-normal levels. This mechanism enhances healing and the body’s antimicrobial defenses. It is believed that HBO augments the efficacy of certain antibiotics (gentamicin, tobramycin and amikacin). Finally, the body’s osteoclast function of removing necrotic bone is dependent on a proper oxygen tension environment; HBO provides this environment. HBO treatments are delivered at a pressure of 2.0 to 2.5 atm for a duration of 90–120 minutes. It is not unusual to receive daily treatments following major debridement surgery. The number of treatments required varies on an individual basis. Medicare Parts A and B can cover the use of HBO for chronic refractory osteomyelitis that has been demonstrated to be unresponsive to conventional medical and surgical management.
- Osteoradionecrosis as an adjunct to conventional treatment (ICD-9-CM diagnosis code 526.89):
- Soft tissue radionecrosis as an adjunct to conventional treatment (ICD-9-CM diagnosis codes 909.2 and990):
HBO use in the treatment of osteoradionecrosis and soft tissue radionecrosis is one part of an overall plan of care. Also included in this plan of care are debridement or resection of non-viable tissues in conjunction with antibiotic therapy. Soft tissue flap reconstruction and bone grafting may also be indicated. The goal of HBO treatment is to increase the oxygen tension in both hypoxic bone and tissue to stimulate growth in functioning capillaries, fibroblastic proliferation and collagen synthesis. The recommended daily treatments last 90–120 minutes at 2.0 to 2.5 atm. The duration of HBO therapy is highly individualized.
- Cyanide poisoning (ICD-9-CM diagnosis code 987.7 and 989.0):
Cyanide poisoning carries a high risk of mortality. Victims of smoke inhalation frequently suffer from both carbon monoxide and cyanide poisoning. The traditional antidote for cyanide poisoning is the infusion of sodium nitrite. This treatment can potentially impair the oxygen-carrying capacity of hemoglobin. Using HBO as an adjunct therapy adds the benefit of increased plasma-dissolved oxygen. HBO benefit for the pulmonary injury related to smoke inhalation remains experimental. The HBO treatment protocol is to administer oxygen at 2.5 to 3.0 atm for up to 120 minutes during the initial treatment. Most patients with combination cyanide and carbon monoxide poisoning will receive only one treatment. This is an emergent condition requiring the continuous presence of the physician beside the chamber.
- Actinomycosis only as an adjunct to conventional therapy when the disease process is refractory to antibiotics and surgical treatment (ICD-9-CM diagnosis codes 039.0–039.4, 039.8 and 039.9):
Actinomycosis is a bacterial infection caused by Actinomyces israelii. Its symptoms include slow-growing granulomas that later break down, discharging viscid pus containing minute yellowish granules. The treatment includes prolonged administration of antibiotics (penicillin and tetracycline). Surgical incision and draining of accessible lesions is also helpful. Only after the disease process has been shown refractory to antibiotics and surgery could HBO be covered by Medicare.
- Diabetic wounds of the lower extremities (ICD-9-CM codes for diabetic complications (250.70–250.73 or 250.80–250.83) must be listed in addition to a covered wound diagnosis code (707.10-707.15, or 707.19) to indicate this condition. See National Coverage Determination (NCD) 20.29 coverage criterion below and special coding instructions in attached article’s “Coding Guideline” section.)
For dates of service on or after April 1, 2003 , HBO therapy is covered for diabetic wounds of the lower extremities in patients who meet the following three criteria per NCD 20.29:
- Patient has type I or type II diabetes and has a lower extremity wound that is due to diabetes;
- Patient has a wound classified as Wagner grade III or higher; and
- Patient has failed an adequate course of standard wound therapy.
Non-Covered Conditions per NCD 20.29
See attached article.
Notice: This LCD imposes diagnosis limitations that support diagnosis to procedure code automated denials. However, services performed for any given diagnosis must meet all of the indications and limitations stated in this policy, the general requirements for medical necessity as stated in CMS payment policy manuals, any and all existing CMS national coverage determinations, and all Medicare payment rules.
As published in CMS IOM 100-08, Section 13.5.1, to be covered under Medicare, a service shall be reasonable and necessary. When appropriate, contractors shall describe the circumstances under which the proposed LCD for the service is considered reasonable and necessary under Section 1862(a)(1)(A). Contractors shall consider a service to be reasonable and necessary if the contractor determines that the service is:
- Safe and effective.
- Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
- Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
- Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
- Furnished in a setting appropriate to the patient’s medical needs and condition.
- Ordered and furnished by qualified personnel.
- One that meets, but does not exceed, the patient’s medical need.
- At least as beneficial as an existing and available medically appropriate alternative.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
13X, 85X
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
Note: TrailBlazer has identified the Bill Type and Revenue Codes applicable for use with the CPT/HCPCS codes included in this LCD. Providers are reminded that not all CPT/HCPCS codes listed can be billed with all Bill Type and/or Revenue Codes listed. CPT/HCPCS codes are required to be billed with specific Bill Type and Revenue Codes. Providers are encouraged to refer to the CMS Internet-Only Manual (IOM) Pub. 100-04, Claims Processing Manual, for further guidance.
0413
CPT/HCPCS Codes
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Note:
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Providers are reminded to refer to the long descriptors of the CPT codes in their CPT books. The American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) require the use of short CPT descriptors in policies published on the Web.
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99183
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Hyperbaric oxygen therapy (Non-OPPS)
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C1300
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Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval (OPPS)
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Medicare Billing Requirements
Claims for this service should be submitted using the ASC X12 837 professional claim format or Form CMS-1500.
The following HCPCS code applies:
• 99183 – Physician attendance and supervision of hyperbaric oxygen therapy, per session.
a. Payment Requirements for A/B MACs (B)
Payment and pricing information will occur through updates to the Medicare Physician Fee Schedule Database (MPFSDB). Pay for this service on the basis of the MPFSDB. Deductible and coinsurance apply. Claims from physicians or other practitioners where assignment was not taken, are subject to the Medicare limiting charge.
Remittance Advice Notices
Use appropriate existing remittance advice remark codes and claim adjustment reason codes at the line level to express the specific reason if you deny payment for HBO therapy for the treatment of diabetic wounds of lower extremities.
The CPT/HCPCS codes included in this LCD will be subjected to procedure to diagnosis editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as not medically necessary.
Medicare is establishing the following limited coverage for CPT/HCPCS codes C1300 and 99183:
Covered for:
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039.0–039.4
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Actinomycotic infections
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039.8–039.9
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Actinomycotic infections
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040.0
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Gas gangrene
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250.70–250.73*
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Diabetes with peripheral circulatory disorders
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Note: A covered wound diagnosis code (707.10–707.15 or 707.19) must be listed in addition to 250.70–250.73 or 250.80–250.83 to indicate this condition. Per NCD 20.29.
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250.80–250.83*
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Diabetes with other specified manifestations
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Note: A covered wound diagnosis code (707.10–707.15 or 707.19) must be listed in addition to 250.70–250.73 or 250.80–250.83 to indicate this condition. Per NCD 20.29.
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444.21–444.22
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Arterial embolism and thrombosis of arteries of the extremities
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444.81
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Arterial embolism and thrombosis of arteries of iliac artery
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526.89
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Osteoradionecrosis of the jaw
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707.10–707.15*
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Ulcer of lower limbs, except decubitus
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Note: ICD-9-CM codes 250.70–250.73 or 250.80–250.83 must be listed in addition to a covered wound diagnosis code (707.10–707.15 or 707.19) to indicate this condition. Per NCD 20.29.
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707.19*
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Ulcer of other part of lower limb
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Note: ICD-9-CM codes 250.70–250.73 or 250.80–250.83 must be listed in addition to a covered wound diagnosis code (707.10–707.15 or 707.19) to indicate this condition. Per NCD 20.29.
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728.86
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Necrotizing fasciitis
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730.10–730.19
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Chronic osteomyelitis
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902.53
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Injury to blood vessels of iliac artery
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903.01
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Injury to blood vessels of axillary artery
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903.1
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Injury to blood vessels of brachial blood vessels
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904.0
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Injury to blood vessels of common femoral artery
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904.41
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Injury to blood vessels of popliteal artery
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909.2*
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Late effect of radiation
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Note: Code also the condition or nature of the late effect, which should be sequenced first.
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927.00–927.03
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Crushing injury of upper limb
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927.09
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Crushing injury of upper limb, multiple sites
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927.10–927.11
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Crushing injury of elbow and forearm
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927.20–927.21
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Crushing injury of wrist and hand(s), except fingers(s) alone
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927.8–927.9
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Crushing injury of upper limb
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928.00–928.01
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Crushing injury of hip and thigh
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928.10–928.11
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Crushing injury of knee and lower leg
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928.20–928.21
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Crushing injury of ankle and foot, excluding toe(s) alone
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928.3
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Crushing injury of toe(s)
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928.8–928.9
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Crushing injury of lower limb
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929.0
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Crushing injury, multiple sites, not elsewhere classified
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929.9
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Crushing injury; unspecified site
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958.0
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Air embolism
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986
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Toxic effect of carbon monoxide
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987.7
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Toxic effect of other hydrocyanic acid gas
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989.0
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Toxic effect of hydrocyanic acid and cyanides
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990*
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Effects of radiation, unspecified
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Note: Code also the specific diagnosis code(s) for the condition or nature of the effect of radiation, if known based on medical record documentation; this code (or codes) should be sequenced first.
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993.2–993.3
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Effects of air pressure
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996.52
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Mechanical complication due to graft of other tissue, not elsewhere classified (skin graft failure or rejection)
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996.90–996.96
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Complications of reattached extremity or body part
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996.99
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Complications of reattached other specified body part
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999.1
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Air embolism to any site following infusion, perfusion, or transfusion
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Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims
Documentation Requirements
Documentation supporting medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.
The documentation present in the clinical record must provide an accurate description and diagnosis of the medical condition supporting that the use of HBO is reasonable and medically necessary. The medical documentation must include but is not limited to the following:
- An initial assessment, which includes a history and physical that clearly substantiates the condition for which HBO is recommended. This should also include any prior medical, surgical and/or HBO treatments.
- Documentation of the procedure (logs) including ascent time, descent time and pressurization level. There should be a treatment plan identifying timeline and treatment goals.
- Physician-to-physician communications or records of consultations and/or additional assessments, recommendations or procedural reports.
- Laboratory reports (cultures or Gram stains) that confirm the diagnosis of necrotizing fasciitis are required and must be present as support for payment of HBO.
- X-ray findings and bone cultures confirming the diagnosis of osteomyelitis are required and must be present as support for payment of HBO.
- Documentation to support the presence of gas gangrene as proven with laboratory reports (Gram stain or cultures) and X-ray.
- Physicians’ progress notes that describe the physical findings, type(s) of treatment(s) provided, number of treatments provided, the effect of treatment(s) received and the assessment of the level of progress made toward achieving the completion of established therapy goals.
- Documentation of date and anatomical site of prior radiation treatments.
- Documentation supporting date of skin graft and compromised state of graft site.
- No payment will be allowed for HBO without documentation that a trained emergency response team is available and that the setting provides the required availability of ICU services that could be needed to ensure the patient’s safety if a complication occurred.
- For diabetic wounds of the lower extremity, the Wagner classification of the wound and the failure of an adequate course (at least 30 days) of standard wound therapy must be documented at the initiation of therapy:
- Documentation must demonstrate an ulcer with bone involvement (osteomyelitis), localized gangrene or gangrene of the whole foot.
- Documentation of standard wound care in patients with diabetic wounds must include: assessment of a patient’s vascular status and documentation of correction of any vascular problems in the affected limb; documentation of optimization of nutritional status; documentation of optimization of glucose control; documentation of debridement by any means to remove devitalized tissue; documentation of maintenance of a clean, moist bed of granulation tissue with appropriate moist dressings; documentation of efforts for appropriate off-loading; and documentation of necessary treatment to resolve any infection that might be present. Failure to respond to standard wound care occurs when there is no documentation of measurable signs of healing for at least 30 consecutive days. The medical record must include, at a minimum, a wound evaluation at least every 30 days during administration of HBO therapy.
