December 2023 Updates

On December 21 2023, CMS issued an update to the previously published payment for HBOT, correcting the unadjusted reimbursement rate for CPT code G0277 (hyperbaric oxygen therapy, per 30 minutes) to $132.21, from $73.64 (See OPPS Addendum B, January 2024). This is a 5.7% INCREASE over 2023 rates rather than the 42% decrease that was initially in the Final Rule. The Alliance and the Undersea and Hyperbaric Medical Society (UHMS) contracted third-parties to conduct an analysis of the data - which confirmed that CMS did in fact make an error when the final rule was issued. 

Background: Changes in Outpatient Payment for Hyperbaric Oxygen Therapy Services

In November 2023 the UHMS and the Alliance of Wound Care Stakeholders identified a significant alteration in reimbursement rates that demands immediate attention of interested parties. The Hospital Outpatient Prospective Payment- Notice of Final Rulemaking with Comment Period (NFRM) for 2024, which was then recently published, set the national unadjusted reimbursement rate for CPT code G0277 (hyperbaric oxygen therapy, per 30 minutes) at $73.64. This is a stark contrast to the anticipated rate of approximately $134 per 30 minutes.

Why This Matters

There was no prior mention of changes to hyperbaric oxygen therapy in the Proposed Rule released in July, implying that this adjustment could have been an error. If left unchanged, this unexpected reduction would have impacted the operational dynamics of Hyperbaric Oxygen Therapy Departments (HOPD) across healthcare institutions.

What Did Stakeholders Do?

A window for commentary on this matter was open, for comments to be submitted by January 1, 2024. Stakeholders in the hyperbaric medicine community across the nation expressed their concerns and sought clarification during this period.

Congratulations to all of those who participated in the commentary period. Your expertise and opinion have been invaluable in shaping the future of hyperbaric medicine reimbursement!