Hyperbaric oxygen (HBO2) treatment for tissue damage

Status: Decision completed

(Including Wound Care and Treatment of Central Nervous Systems (CNS) Conditions)

Policy context

For HBO2 treatment, important questions center on the effectiveness of treatment for some conditions, as well as the frequency, dose and duration treatment. The list of applications for HBO2 treatment has expanded beyond those approved by the Food and Drug Administration (FDA) or currently covered by the Center for Medicare Services (CMS).

Primary criteria ranking

  • Safety = Medium
  • Efficacy = High
  • Cost = High

Assessment timeline

  • Draft key questions published: May 24, 2012
  • Public comment period: May 24 to June 11, 2012
  • Draft report published: January 4, 2013
  • Public comment period: January 7 to February 7, 2013
  • Final report published: February 18, 2013
  • HTCC public meeting: March 22, 2013


Hyperbaric oxygen (HBO2) treatment involves the systemic administration of pure gaseous oxygen under pressures greater than 1 atmosphere in a specialized chamber. Hyperbaric oxygen may also be administered in a multiplace chamber in which patients breathe 100% oxygen through a facemask or similar device with the surrounding air pressure increased to 2 to 3 times the atmospheric pressure. The elevated concentration and pressure of the oxygen allows higher levels of oxygen absorption by blood, creating hyperoxygenation in the tissues. Potential benefits of hyperbaric therapy include that it may reduce edema, promote antimicrobial activity, enhance the immune response, and facilitate the formation of collagen, blood vessels, and other tissues. For chronic conditions, HBO2 treatment is typically employed as an adjunct to surgical or pharmacological interventions. HBO2 treatment is a relatively safe procedure, but does carry some risks due to the increased pressure and hyperoxia. The only absolute contraindication is an untreated tension pneumothorax. Relative contraindications include impaired pressure equalization and cardiac disease.