Arkansas Administrative Code
Agency 016 - DEPARTMENT OF HUMAN SERVICES
Division 06 - Medical Services
Rule 016.06.06-012 - Ambulatory Surgical Center Update No. 64; Hospital Update No. 91 and Physician/Independent Lab/CRNA/Radiation Therapy Center Update No. 109

Hyperbaric Oxygen Therapy (HBO) involves exposing the body to oxygen under pressure greater than one atmosphere. Such therapy is performed in specially constructed hyperbaric chambers holding one or more patients, although, oxygen may be administered in addition to the hyperbaric treatment itself. Patients should be assessed for contraindications such as sinus disease or claustrophobia prior to therapy. In some diagnoses, hyperbarics is only an adjunct to standard surgical therapy. These indications are taken from "The Hyperbaric Oxygen Therapy Committee Report" (2003) of The Undersea and Hyperbaric Medical Society (Kensington, MD).

All hyperbaric therapy will require prior approval, except in emergency cases such as for air embolism or carbon monoxide poisoning. Prior approval will be for a certain number of treatments. A copy of the approval letter must be filed with each claim and the number in the series of treatments documented. Further treatments will require reapplication for a prior approval. Documentation for prior approval should include, but not be limited to, a complete physician SOAP note, a physical exam and prior therapy treatment failures, including antibiotic therapies and surgical interventions. It must include a clear description of the wound with each claim. Documentation of no measurable signs of healing for at least 30 consecutive days of wound care therapy prior to the start of HBO therapy should be included (for those diagnoses requiring this treatment plan). If an extension of benefits is needed, the above documentation must be submitted. Physician progress notes with physical findings at each treatment and the effects of treatment and wound description will be needed for an extension. Any questions may be addressed to the Medical Director at 501-682-9868.

Requests for prior approval may be mailed or faxed.

The following tables provide explanation of diagnosis requirements and treatment number and treatment schedules.

ªThree times a day -Twice a day

Refer to section 272.404 of this manual for billing instructions.

Physicians may be reimbursed for attendance and supervision of hyperbaric oxygen therapy.

Hyperbaric oxygen therapy involves exposing the body to oxygen under pressure greater than one atmosphere. Such therapy is performed in specially constructed hyperbaric chambers holding one or more patients; although oxygen may be administered in addition to the hyperbaric treatment. Patients should be assessed for contraindications such as sinus disease or claustrophobia prior to therapy. In some diagnoses, hyperbarics is only an adjunct to standard surgical therapy. These indications are taken from "The Hyperbaric Oxygen Therapy Committee Report" (2003) of The Undersea and Hyperbaric Medical Society (Kensington, MD).

Physicians may be reimbursed for attendance and supervision of hyperbaric oxygen therapy. Physicians billing for the physician component of "Physician attendance and supervision of hyperbaric oxygen therapy" may bill for only one unit of service per day. The physician's charge for each service date must include all his or her hyperbaric oxygen therapy charges, regardless of how many treatment sessions per day are administered.

Hyperbaric Oxygen Therapy (HBO) involves exposing the body to oxygen under pressure greater than one atmosphere. Such therapy is performed in specially constructed hyperbaric chambers holding one or more patients, although oxygen may be administered in addition to the hyperbaric treatment itself. Patients should be assessed for contraindications such as sinus disease or claustrophobia prior to therapy. In some diagnoses, hyperbarics is only an adjunct to standard surgical therapy. These indications are taken from "The Hyperbaric Oxygen Therapy Committee Report" (2003) of The Undersea and Hyperbaric Medical Society (Kensington, MD).

All hyperbaric therapy will require prior approval, except in emergency cases such as for air embolism or carbon monoxide poisoning. Prior approval will be for a certain number of treatments. A copy of the approval letter must be filed with each claim and the number in the series of treatments documented. Further treatments will require reapplication for a prior approval. Documentation for prior approval should include, but not be limited to, a complete physician SOAP note, a physical exam and prior therapy treatment failures, including antibiotic therapies and surgical interventions. It must include a clear description of the wound with each claim. Documentation of no measurable signs of healing for at least 30 consecutive days of wound care therapy prior to the start of HBO therapy should be included (for those diagnoses requiring this treatment plan). If an extension of benefits is needed, the above documentation must be submitted. Physician progress notes with physical findings at each treatment and the effects of treatment and wound description will be needed for an extension. Any questions may be addressed to the Medical Director at 501-682-9868.

Requests for prior approval may be mailed or faxed.

The following tables provide explanation of diagnosis requirements and treatment number and treatment schedules.

Ambulatory Surgical Center

ªThree times a day ""Twice a day

Refer to section 242.145 of this manual for billing instructions.