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Diabetic Foot Ulcer Treatment in Marietta: When Medicare May Cover Hyperbaric Oxygen 11/3/26
November is Diabetes Awareness Month, and November 14 is World Diabetes Day. It's a good time to talk about one of the most serious problems diabetes can cause: a foot wound that won't close.
If you or someone you care for has a diabetic foot ulcer, you may have heard about hyperbaric oxygen therapy (HBOT). You may also have heard that Medicare covers it. Both can be true, but only in certain cases. This guide walks through Medicare's rules in plain English so you know what to ask your doctor.
What is a diabetic foot ulcer?
A diabetic foot ulcer is an open sore, usually on the bottom of the foot or on a toe. Diabetes can dull the feeling in your feet and reduce blood flow to them. That means a small blister or cut can go unnoticed and get worse.
Some ulcers stay shallow. Others go deep into tendon or bone, or become infected. The deeper the wound and the more infection there is, the more serious it is.
The Wagner scale, in plain words
Many doctors grade diabetic foot wounds on the Wagner scale, which runs from 0 to 5:
Grade 0: no open wound, but the foot is at risk
Grade 1: a shallow ulcer
Grade 2: a deeper ulcer that reaches tendon, joint or bone
Grade 3: a deep ulcer with an abscess or bone infection (osteomyelitis)
Grade 4: gangrene in part of the foot
Grade 5: gangrene of the whole foot
Medicare's rule for HBOT starts at grade 3. Your wound care doctor or podiatrist decides the grade, and it should be written in your chart.
Medicare's three requirements for HBOT and diabetic foot wounds
Medicare's national policy on hyperbaric oxygen is called NCD 20.29. For diabetic wounds of the legs and feet, it lists three requirements:
You have type 1 or type 2 diabetes, and the wound is caused by diabetes.
The wound is Wagner grade 3 or higher.
You have had an adequate course of standard wound care, and it hasn't worked.
"Hasn't worked" has a specific meaning. Medicare says there must be no measurable signs of healing for at least 30 days in a row of standard wound care. HBOT is then added on top of that care. It never replaces it.
Even when all three are met, coverage depends on what your medical records show. Medicare Advantage and private plans can have their own rules and often require approval first.
What counts as standard wound care?
This part surprises a lot of families. Medicare spells out what standard care includes:
Checking blood flow to the leg, and fixing blood flow problems when possible
Good nutrition
Good blood sugar control
Debridement, which means removing dead tissue from the wound
Keeping the wound clean and moist with the right dressings
Off-loading, which means taking pressure off the wound with a special boot, shoe or cast
Treating any infection
So if a wound has been open for a month but nobody has checked circulation or taken pressure off it, it may not qualify yet. That isn't a "no" forever. It often means the next step is getting that care in place and written down.
If HBOT is approved, what happens?
During HBOT you rest in a pressurized chamber and breathe 100% oxygen. Sessions are usually once a day on weekdays, and a full course often lasts several weeks. Your hyperbaric doctor sets the plan. The most common side effect is pressure in the ears, similar to flying. Your care team will review the risks with you before you start.
Medicare also requires the wound to be checked at least every 30 days during HBOT. If there are no measurable signs of healing in any 30-day stretch, Medicare stops covering more treatment. Your care team uses these checks to see whether treatment is helping.
At HyOx in Marietta, treatment takes place in a 31 x 9 ft walk-in multiplace chamber that seats up to 12 patients. A trained attendant is in the chamber with patients during every session.
What the research says, honestly
HBOT for diabetic foot ulcers has been studied for decades, and the results are mixed.
A well-known randomized trial from Sweden (Löndahl and colleagues, 2010) found that more ulcers had healed at one year in patients who got HBOT than in patients who got a placebo treatment. Both groups also had standard wound care. The 2023 guideline from the International Working Group on the Diabetic Foot (IWGDF) gives HBOT a conditional recommendation as an add-on for ulcers with reduced blood flow (ischemic or neuro-ischemic) that have not healed with the best standard care alone. It rates the evidence as low certainty and found no good evidence that HBOT prevents amputation.
Other studies have not found a clear benefit, including a 2018 trial in patients with poor blood flow to the leg. A 2015 Cochrane review found some short-term benefit but said the evidence was not strong enough to be sure about long-term healing or amputation.
What does that mean for you? HBOT is not right for every foot wound, and it doesn't help everyone. It is one tool that may help certain patients when standard care alone hasn't been enough.
Questions to ask your doctor this World Diabetes Day
What Wagner grade is my wound, and is it in my chart?
Has my blood flow been checked?
Am I taking pressure off the wound the right way?
Has the wound measurably improved in the last 30 days?
Would a hyperbaric evaluation make sense for me?
For referring physicians
HyOx accepts referrals for diabetic lower-extremity wounds that may meet NCD 20.29. Helpful records include diabetes type, Wagner grade, serial wound measurements covering at least 30 consecutive days of standard care, vascular assessment and any revascularization, off-loading method, debridement history, recent A1c, nutrition status, and infection workup, including osteomyelitis imaging or cultures. Our hyperbaric physicians review the record, screen for contraindications, and decide whether HBOT is appropriate. HBOT runs alongside your wound care plan, not in place of it, and wounds are reassessed at least every 30 days.
Records can be faxed to 678.303.3205.
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Next step
If you have a diabetic foot wound that hasn't improved, ask your doctor whether a hyperbaric evaluation makes sense. Your doctor can send us a referral, or you can reach out to us yourself.
Request an appointment → or call 678.303.3200.
Contact HyOx Medical Treatment Center
2550 Windy Hill Road SE, Suite 110, Marietta, GA 30067
Phone: 678.303.3200 | Fax: 678.303.3205 | Email: office@hyox.com
This article is for general education and is not medical advice. Hyperbaric oxygen therapy (HBOT) is used together with standard medical care, not in place of it, and it is not right for everyone. A physician evaluation is required before treatment, and results vary from person to person. HBOT has risks, including ear and sinus pressure injury (barotrauma), anxiety from being in an enclosed space, temporary changes in vision and, rarely, a seizure caused by oxygen toxicity. Medicare and other insurance may cover HBOT only when specific medical criteria are met and documented, and individual plans vary. If you have a medical emergency, call 911.
References
Centers for Medicare & Medicaid Services. National Coverage Determination 20.29: Hyperbaric Oxygen Therapy. Medicare National Coverage Determinations Manual, Pub. 100-03. https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?NCDId=12
Huang ET, ed. UHMS Hyperbaric Medicine Indications Manual. 15th ed. North Palm Beach, FL: Best Publishing Company; 2023.
Chen P, Campillo Vilorio N, Dhatariya K, et al. Guidelines on interventions to enhance healing of foot ulcers in people with diabetes (IWGDF 2023 update). Diabetes Metab Res Rev. 2024;40(3):e3644. doi:10.1002/dmrr.3644
Löndahl M, Katzman P, Nilsson A, Hammarlund C. Hyperbaric oxygen therapy facilitates healing of chronic foot ulcers in patients with diabetes. Diabetes Care. 2010;33(5):998-1003. doi:10.2337/dc09-1754
Kranke P, Bennett MH, Martyn-St James M, Schnabel A, Debus SE, Weibel S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2015;(6):CD004123. doi:10.1002/14651858.CD004123.pub4
Santema KTB, Stoekenbroek RM, Koelemay MJW, et al. Hyperbaric oxygen therapy in the treatment of ischemic lower-extremity ulcers in patients with diabetes: results of the DAMO2CLES multicenter randomized clinical trial. Diabetes Care. 2018;41(1):112-119. doi:10.2337/dc17-0654
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