Clinical Context
A typical patient is an adult with a chronic, non-healing wound such as a diabetic foot ulcer, refractory osteoradionecrosis, or refractory soft tissue radionecrosis referred to a hyperbaric oxygen (HBO) facility. The patient arrives to an outpatient hyperbaric suite or hospital-based hyperbaric medicine unit for a planned course of C1300 therapy. Intake includes verification of indications, consent, and pre-treatment evaluation by a hyperbaric medicine physician or qualified clinician. Vital signs and a focused history (including recent chemotherapy, pneumothorax history, claustrophobia, and pulmonary status) are reviewed. The patient is assisted into a full-body monoplace chamber or a multiplace chamber depending on facility capability and staffing.
During treatment, the chamber is pressurized to the prescribed atmospheric pressure (commonly 2.0–2.5 ATA) while the patient breathes 100% oxygen for the therapeutic period. Monitoring during each C1300 30-minute interval includes observation for barotrauma, oxygen toxicity symptoms, and claustrophobic distress. Nursing or hyperbaric technologist documents start and stop times, any interruptions, and patient tolerance. Typical course ranges from 20 to 40 treatments delivered once daily, five days per week, depending on indication and clinical response. Post-treatment, the clinician documents skin and wound status changes, any adverse events, and schedules subsequent sessions or follow-up care.
Coding Specifications
| Modifier | Description | When to Use |
|---|
26 | Professional component | Use when billing only the physician interpretation or professional portion associated with the hyperbaric service if applicable. |
| TC | Technical component | Use when billing only the facility or equipment component for the hyperbaric session.
| 59 | Distinct procedural service | Use when a separate, distinct service is performed that is not usually reported with the hyperbaric session.
| 76 | Repeat procedure by same physician | Use when a planned repeat hyperbaric session is billed on the same day by the same provider (rare for C1300).
| 77 | Repeat procedure by another physician | Use when a repeat session is performed the same day by a different physician.
| GT | Via interactive audio and video telecommunications | Use when telehealth supervision or remote physician oversight meets payer criteria during a portion of care.
| 25 | Significant, separately identifiable evaluation and management service | Use when a separate E/M visit is provided on the same day as the hyperbaric session and is documented as distinct.
| 22 | Increased procedural services | Use when unusually high complexity or time justifies additional payment and documentation supports increased work.
| 52 | Reduced services | Use when a session is partially reduced, interrupted, or shortened and lower reimbursement is appropriate.
| 59 | Distinct procedural service | Use when a procedure performed is distinct or independent from other services on the same day. (Note: some payers prefer modifier X{EPSU} modifiers instead.)
| Taxonomy Code | Specialty | Notes |
|---|
207P00000X | Hyperbaric Medicine Physician | Physicians certified or practicing in hyperbaric medicine who provide evaluation and treatment oversight. |
| 251B00000X | Wound Care Specialist | Clinicians focused on wound management who commonly refer and coordinate HBO therapy.
| 363A00000X | Registered Nurse | Nurses trained in hyperbaric therapy assist with treatment delivery and monitoring.
| 3456S0501X | Respiratory Therapist | Respiratory therapists may be involved in oxygen delivery equipment and monitoring during sessions.
| 203L00000X | Emergency Medicine Physician | Emergency medicine clinicians may admit or consult for acute issues related to HBO therapy.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|
E11.621 | Type 2 diabetes mellitus with foot ulcer | Diabetic foot ulcers are a common indication for adjunctive hyperbaric oxygen therapy to promote wound healing. |
| M86.171 | Chronic osteomyelitis, right tibia and fibula | Refractory osteomyelitis may be treated with adjunctive HBO to enhance tissue oxygenation and antibiotic efficacy.
| T86.818A | Other complications of transplanted organ and tissue, initial encounter | Selected complex wound or ischemic complications post-transplant may be considered for HBO under specific circumstances.
| L89.309 | Pressure ulcer of sacral region, stage 3, unspecified | Non-healing pressure injuries are an established indication for HBO in select patients.
| C78.7 | Secondary malignant neoplasm of liver and intrahepatic bile duct | Radiation-induced soft tissue and bone necrosis post-oncologic therapy is a typical indication for HBO; metastatic code shown as example of oncology context.
| S91.311A | Laceration without foreign body of right great toe with damage to nail, initial encounter | Acute traumatic wounds with compromised healing can be adjunctively treated with HBO in select cases.
| L08.9 | Local infection of the skin and subcutaneous tissue, unspecified | Complex soft tissue infections, when combined with surgical debridement and antibiotics, may prompt adjunctive HBO.
| K51.90 | Ulcerative colitis, unspecified, without complications | Certain ischemic or radiation-induced gastrointestinal complications have historical off-label consideration for HBO in specialized settings.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|
99213 | Office or other outpatient visit for the evaluation and management of an established patient, typically 15 minutes | Frequently used for pre-treatment evaluation or routine follow-up visits associated with the hyperbaric therapy course. |
| 99354 | Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service (first hour) | May apply when extended face-to-face evaluation is provided on the day of hyperbaric treatment and documented per payer rules.
| 94010 | Spirometry -- for diagnostic assessment | Used when pulmonary function testing is required to evaluate risk for barotrauma or oxygen toxicity prior to initiating HBO therapy.
| 99070 | Supplies and materials (e.g., dressings, sterile trays) provided during patient care, not otherwise billed | Used for non-reimbursable supplies associated with wound care provided in conjunction with HBO sessions.
| G0378 | Physician or other qualified health care professional services for outpatient smoking and tobacco-use cessation counseling visit | Occasionally relevant when counseling for wound healing risk modification (behavioral counseling integrated into care plan).