Hyperbaric Oxygen Therapy for Wound Healing

How HBOT helps wounds heal

Hyperbaric oxygen therapy (HBOT) means breathing pure oxygen in a sealed chamber at higher than normal air pressure. The Undersea and Hyperbaric Medical Society (UHMS) says medical treatment uses at least 2.0 atmospheres absolute (ATA), about twice normal air pressure, for 90 to 120 minutes at a time (UHMS).

Wounds that won't heal are often short of oxygen. The higher pressure helps your blood carry more oxygen to injured tissue. That extra oxygen helps in three main ways:

• Oxygen for healing tissue. Cleveland Clinic says oxygen helps your tissues heal and stand up to infection (Cleveland Clinic, 2023).
• New blood vessels and skin. HBOT helps your body grow new skin, blood vessels and connective tissue (same source).
• Fighting infection and swelling. It helps your white blood cells fight infection. MedlinePlus adds that it can reduce swelling and help wounds, especially infected ones, heal faster (MedlinePlus, 2024).

For more on how the chamber works, see what HBOT is.

Which wounds HBOT is used for

HBOT is used for a specific set of wounds and tissue injuries. Three lists matter here: the UHMS indications, Medicare's coverage rule and the FDA's cleared uses. They overlap but don't match exactly.

The UHMS recognizes these wound-related uses (UHMS):

• Selected problem wounds. The UHMS says the best evidence is for diabetic foot ulcers that are infected, short of blood flow and Wagner grade III or worse.
• Delayed radiation injury. Damage to soft tissue or bone that shows up months or years after radiation treatment for cancer.
• Compromised grafts and flaps. Skin grafts or tissue flaps that are failing. The UHMS says HBOT is not needed for normal, healthy grafts.
• Necrotizing soft tissue infections. Fast-spreading infections that kill tissue. HBOT is an add-on to surgery and antibiotics.
• Crush injury and compartment syndrome. Serious injuries that cut off blood flow to a limb.
• Refractory osteomyelitis. A bone infection that hasn't cleared with standard treatment.
• Gas gangrene. A rare, dangerous infection (clostridial myonecrosis).

The UHMS also lists acute thermal burns. Medicare does not cover HBOT for burns (CMS, NCD 20.29).

What "Wagner grade III" means

The Wagner scale grades how deep a diabetic foot ulcer goes, from 1 to 5. Grade 3 ulcers are deep wounds with a skin infection (cellulitis) or a pocket of pus (abscess), often with a bone infection too. Grades 4 and 5 involve dead tissue (gangrene) in part or all of the foot (American Family Physician, 2009). Shallower ulcers, grades 1 and 2, don't meet Medicare's rule for HBOT.

Wounds HBOT usually isn't used for

Many common chronic wounds are not on Medicare's covered list. The NCD names skin ulcers, bedsores (decubitus ulcers), stasis ulcers and chronic peripheral vascular insufficiency as not covered (CMS, NCD 20.29). If you have one of these, ask your doctor what treatments fit your wound.

What the evidence says about HBOT for wound healing

The evidence is real but mixed. HBOT seems to speed healing for some diabetic foot ulcers in the short term. The long-term benefit is less clear.

A key trial in diabetic foot ulcers (2010). A Swedish trial gave 94 people with chronic diabetic foot ulcers 40 sessions of either HBOT or pressurized air (a placebo) over eight weeks. Both groups also had regular wound care. At one year, the ulcer had fully healed in 52% of the HBOT group and 29% of the placebo group (Löndahl et al., Diabetes Care, 2010).

A Cochrane review of chronic wounds (2015). Cochrane reviews pool the best trials on a question. This one included 12 trials with 577 people, mostly with diabetic foot ulcers. HBOT improved healing at six weeks, but the benefit wasn't clear at one year. There was no clear difference in major amputations. The authors said design and reporting flaws in the trials limit confidence in the results (Kranke et al., Cochrane, 2015).

A trial in wounds with poor blood flow (2018). The Dutch DAMO2CLES trial randomly assigned 120 people with diabetes and a leg wound caused by poor blood flow (ischemia). Half had standard care. Half had standard care plus HBOT. Adding HBOT did not significantly improve wound healing or saving the limb at 12 months. About a third of the HBOT group (21 of 60) couldn't finish the planned treatment (Santema et al., Diabetes Care, 2018).

Radiation injury (2023). A Cochrane review of 18 trials with 1,071 people found HBOT may improve late radiation injury to the head, neck, bladder and rectum. It may also lower the chance of a surgical wound reopening after head and neck surgery. The certainty of the evidence was mostly low (Lin et al., Cochrane, 2023).

The honest limits

• It's an add-on. Every trial above tested HBOT alongside standard care, not instead of it.
• Short-term gains may fade. The 2015 Cochrane review found the six-week benefit wasn't clear at one year.
• Not every wound responds. The 2018 trial found no clear benefit in wounds caused by poor blood flow.
• Many trials are small. Larger, better trials are still needed, according to both Cochrane reviews.

Medicare coverage for wounds: what NCD 20.29 says

Medicare Part B may cover HBOT for wounds when you have a qualifying condition and the treatment is given in a chamber (Medicare.gov). The rules come from National Coverage Determination (NCD) 20.29, in the version effective April 3, 2017 (CMS, NCD 20.29).

Diabetic foot and leg wounds

For a diabetic wound, you must meet all three of these:

1. You have type 1 or type 2 diabetes and a wound on your lower leg or foot caused by diabetes.
2. The wound is Wagner grade III or higher.
3. Standard wound care has failed. Medicare defines this as no measurable signs of healing for at least 30 days in a row.

HBOT must be used together with standard wound care. Your wound must be checked at least every 30 days during treatment. If it shows no measurable healing in any 30-day period, Medicare stops paying for more HBOT.

What "standard wound care" means to Medicare

The NCD lists what standard care includes:

• checking blood flow in the leg and fixing problems where possible
• good nutrition and blood sugar control
• removing dead tissue (debridement)
• keeping the wound clean and moist with the right dressings
• taking pressure off the wound (off-loading)
• treating any infection

Ask your wound team to record each of these. The records are what Medicare and other insurers review.

Other wound conditions Medicare covers

Medicare also covers HBOT for these wound-related conditions (CMS, NCD 20.29):

• compromised skin grafts (not for routine wound care)
• chronic refractory osteomyelitis that hasn't responded to standard medical and surgical care, as an add-on
• osteoradionecrosis and soft tissue radionecrosis (radiation damage), as an add-on
• necrotizing fasciitis and gas gangrene
• crush injuries and acute traumatic peripheral ischemia, as an add-on when a limb, its function or life is at risk
• acute peripheral arterial insufficiency

What you pay

With Original Medicare, you usually pay 20% of the Medicare-approved amount, and the Part B deductible may apply (Medicare.gov). Medicare Advantage and private coverage varies by plan. Our insurance guide covers private plans and appeals, and our cost guide shows published prices.

» Related: Does insurance cover HBOT?

What a wound-care course of HBOT looks like

Wound treatment takes many visits. Cleveland Clinic says sessions usually last one to two hours, and may be scheduled up to five days a week for 30 or more sessions in total (Cleveland Clinic, 2023). The UHMS says most conditions need daily treatments for several weeks (UHMS). In the 2010 diabetic foot trial, people had 40 sessions over eight weeks (Löndahl et al., 2010).

Here is what to expect:

• A referral and screening first. Your doctor or wound team checks whether your wound qualifies and whether HBOT is safe for you.
• Wound care keeps going. Dressings, debridement, off-loading and infection treatment continue. HBOT is added on top.
• Regular wound checks. Your team measures the wound over time. For Medicare, this happens at least every 30 days.
• A set schedule. Most people come in on weekdays for several weeks. Your doctor sets the number of sessions.

During a session, you lie in a clear tube or sit in a pressurized room while staff watch you. Your ears may feel full as the pressure rises. HBOT has side effects, most often ear pain from pressure. Read about HBOT side effects and what to expect before you start.

Hospital wound centers vs wellness centers

Wound HBOT is a medical treatment. It happens in a hard-shell chamber at 2.0 ATA or higher, with a doctor prescribing and supervising it (UHMS). Medicare pays only for HBOT given in a chamber (Medicare.gov).

Some wellness centers and spas offer "mild" HBOT in soft, inflatable chambers. These are not used to treat wounds:

• They run at low pressure. The UHMS calls mild HBOT, below 1.5 ATA, unproven (UHMS).
• They're cleared for one use. Soft chambers have FDA clearance for acute mountain sickness only (UHMS, 2018).
• The UHMS doesn't recommend them for wounds. It does not recommend mild hyperbaric therapy for any medical purpose other than acute mountain sickness (same source).

A slow-healing wound needs a full medical team, not just a chamber. Our mild vs hard-shell HBOT guide explains the difference.

» Related: Mild vs hard-shell HBOT

Questions to ask a hyperbaric wound care center

Call before your first visit and ask:

1. Is HBOT used for my type of wound? And does my wound meet Medicare's or my plan's rules?
2. Is the facility accredited by the UHMS? The UHMS sets accreditation criteria for hyperbaric facilities and encourages every facility to join (UHMS).
3. Who prescribes and supervises my sessions? The UHMS says a trained doctor should.
4. What pressure do you use, and is the chamber hard-shell? Medical HBOT runs at 2.0 ATA or higher.
5. Will you keep treating my wound alongside HBOT? Ask who handles dressings, debridement and off-loading.
6. How often will you measure the wound? And what happens if it isn't improving?
7. Do you bill Medicare or my plan? Ask the center to check your benefits and get any prior approval in writing.

The FDA regulates hyperbaric chambers as Class II medical devices. You can look up a cleared chamber under product code CBF in the FDA's 510(k) database (FDA, 2025).

When to call your doctor

Call your doctor or wound team soon if a wound hasn't started to heal after a few weeks of care. Get help the same day if a wound shows signs of spreading infection, such as growing redness, warmth, swelling, pus or a fever. If you have diabetes, check your feet daily and report any new sore.

Ask your doctor directly whether HBOT fits your wound. They can refer you to a hospital wound center if it does.

The takeaway

HBOT can help some hard-to-heal wounds, mainly deep diabetic foot ulcers, radiation damage and failing skin grafts. It works best as part of full wound care at a hospital-based center, not as a stand-alone fix. This guide is general information, not medical advice. Talk to your doctor, check your plan, then use the list of medical HBOT providers below to compare centers in your state.