Hyperbaric Oxygen Therapy Medical Policy Updates

Harvard Pilgrim is updating our commercial Hyperbaric Oxygen Therapy Medical Policy, effective for dates of service beginning Oct. 1, 2020.

Among other updates, the policy will be enhanced to include specific criteria for outpatient treatment, as well as a number of specific coverage exclusions, and prior authorization will be required for coverage of HCPCS code G0277 (Hyperbaric oxygen under pressure, full body chamber, per 30-minute interval). For complete information, please refer to Harvard Pilgrim’s updated Hyperbaric Oxygen Therapy Medical Policy.

Publication Information

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,

Joseph O’Riordan,

Kristin Edmonston,
Production Coordinator