Systemic hyperbaric oxygen pressurization is a mode of medical treatment in which the patient is entirely enclosed in chamber, pressurized at 1.4-3.0 atmospheres absolute (atm abs) and breathing oxygen.  This increases oxygen levels in systemic circulation.  Treatment may be carried out either in a monoplace chamber pressurized with pure oxygen, or in a larger, multiplace chamber pressurized with compressed air, in which case the patient receives pure oxygen by mask, head tent, or endotracheal tube. 

Topical hyperbaric oxygen therapy is a technique of delivering 100% oxygen directly to an open moist wound at a pressure slightly higher than atmospheric pressure.  It is hypothesized that the high concentrations of oxygen diffuse directly in to the wound to increase the local cellular oxygen tension, which in turn promotes wound healing. 

Medically Necessary:

1. Systemic hyperbaric oxygen pressurization is considered medically necessary as a primary therapy in the treatment of any of the following conditions:
   
   
   • Carbon monoxide poisoning; or
   • Cerebral edema; or
   • Cyanide poisoning; or
   • Decompression sickness; or
   • Gas embolism; or
   • Profound anemia with exceptional blood loss:  when transfusion is impossible or delayed; or
   • Prophylactic pre and post treatment for patients undergoing dental surgery of a radiated jaw.
     
     
2. Systemic hyperbaric oxygen pressurization is considered medically necessary when used as adjuvant therapy in conjunction with standard medical and/or surgical treatment for any of the following conditions:
   
   
   • Acute or chronic refractory osteomyelitis (refractory osteomyelitis); or
   • Acute peripheral arterial insufficiency (compartment syndrome); or
   • Acute thermal burns: deep second degree or third degree in nature; or
   • Acute traumatic ischemia; or
   • Chronic non-healing wounds; or
   • Compartment syndrome; or
   • Compromised skin grafts or flaps  (enhancement of healing in selected wounds); or
   • Crush injuries; or
   • Gas gangrene (i.e., clostridial myositis and myonecrosis); or
   • Intracranial abscess; or
   • Necrotizing soft-tissue infections; or
   • Radiation necrosis (osteoradionecrosis and soft tissue radiation necrosis).

Not Medically Necessary:

If the wound fails to show measurable signs of healing within 30 days of HBOT therapy, the therapy is considered not medically necessary.

Investigational/Not Medically Necessary:

Topical hyperbaric oxygen is considered investigational/not medically necessary in all cases.

Limb specific hyperbaric oxygen pressurization is considered investigational/not medically necessary in all cases.

Systemic hyperbaric oxygen pressurization is considered investigational/not medically necessary in all cases not previously listed including but not limited to the following:

• Acute carbon tetrachloride poisoning; or
• Alzheimer’s Disease; or
• Arthritic Diseases; or
• Bone grafts; or
• Brown recluse spider bites; or
• Cerebrovascular accident, acute (thrombotic or embolic); or
• Chemical pulmonary damage (smoke inhalation, carbon tetrachloride and hydrogen sulfide poisoning) and/or pulmonary insufficiency; or
• Fracture healing; or
• Hydrogen sulfide poisoning; or
• Idiopathic sudden deafness (hypoacusis); or
• Intra-abdominal and intracranial abscesses; or
• Korsakoff’s Disease; or
• Lepromatous leprosy; or
• Lyme Disease; or
• Meningitis; or
• Multiple sclerosis; or
• Myocardial Infarction; or
• Organ transplantation; or
• Pick’s disease; or
• Pseudomembranous colitis, antibacterial agent induced colitis; or
• Pyoderma gangrenosum; or
• Radiation myelitis, enteritis, or proctitis; or
• Retinal artery insufficiency; or
• Retinopathy, as an adjunct to scleral buckling procedures for patients with sickle cell peripheral retinopathy and retinal detachment; or
• Senility; or
• Septicemia due to anaerobic bacteria other than Clostridia; or
• Severe or refractory Crohn’s disease; or
• Sickle cell crisis with or without hematuria; or
• Spinal cord injury; or
• Tetanus; or
• Traumatic brain injury.

Rationale

Systemic Hyperbaric Oxygen

This policy regarding systemic hyperbaric oxygen is based on guidelines published by the Undersea and Hyperbaric Medical Society.  

Topical Hyperbaric Oxygen

Due to their different methods of delivery, topical and systemic hyperbaric oxygen are distinct technologies such that the outcomes associated with systemic hyperbaric oxygen therapy cannot be extrapolated to topical therapy.  Topical hyperbaric oxygen has been primarily investigated as a treatment of chronic wounds.  However, there is inadequate published data from controlled trials to permit scientific conclusions. 

Background/Overview

Guidelines:

The Undersea and Hyperbaric Medical Society’s 2003 Hyperbaric Oxygen Therapy Committee suggests utilization of hyperbaric oxygen therapy (HBOT) guidelines as described below:

1. Acute traumatic ischemia - 3 treatments per day for 48 hours followed by 2 treatments per day over the second 48 hours and 1 treatment per day over the third period of 48 hours.  Beyond this time period, utilization review should be obtained;
   
   
2. Air or Gas Embolism - no more than 10 sessions should be needed to treat;
   
   
3. Carbon Monoxide Poisoning - actual treatment pressure and time will vary, but compressions should be between 2.4 and 3.0 atm abs.  In patients with persistent neurologic dysfunction after the initial treatment, subsequent treatments may be performed within 6-8 hours and continued once or twice daily until there is no further improvement in cognitive functioning.  No more that 5 sessions should be needed to treat;
   
   
4. Cerebral Edema - HBOT treatment is administered at a pressure of 2.0 to 2.5 atm abs, with oxygen administration from 60 to 90 minutes per treatment.  HBOT treatment may be one or two sessions per day depending on the condition of the individual patient.  No more than 20 treatments should be needed to treat;
   
   
5. Compromised Skin Grafts - HBOT usually starts twice a day and is then reduced to once a day when the graft appears stable.  HBOT is not necessary for normal un-compromised skin grafts or flaps;
   
   
6. Cyanide Poisoning - usually requires HBOT at 2.5 - 3.0 atm abs for up to 120 minutes.  Most patients with cyanide poisoning will receive only one treatment;
   
   
7. Decompression Sickness - treatment times vary, depending upon length of time elapsed between symptoms and initiation of treatment and between residual symptoms after initial treatment.  Usual time between treatments ranges from 1.5 to 14.0 hours.  Repetitive treatments may be necessary, depending upon the patient’s response;
   
   
8. Exceptional Blood Loss Anemia - for class IV hemorrhage HBOT can be administered safely at pressures up to 3 atm abs for 2 to 4 hour periods three or four times daily.  The vital capacity should be monitored to assess the extent of pulmonary oxygen toxicity. HBOT should be discontinued when the red blood cells have been replaced and the signs and symptoms of tissue hypoxia have been alleviated (approximate hemoglobin of 6-8 g/dl).  HBOT is indicated when the patient will not accept blood replacement for medical or religious reasons and the following symptoms are present:
   
   
   1. shock, systolic blood pressure below 90 mmHg, or pressure maintained by vasopressors;
   2. disorientation to coma; 
   3. ischemic changes of the myocardium as demonstrated on the EKG; and
   4. ischemic gut. 
   5. HBOT therapy is continued as needed and discontinued when the red blood cells have been replaced in numbers to alleviate the preceding signs and symptoms;
      
      
9. Gas Gangrene - the recommended treatment profile consists of 100% oxygen at 3.0 atm abs pressure for 90 minutes, 3 times in the first 24 hours and then twice per day for the next 4-5 days.  The decision to terminate treatment depends upon the patient’s response to HBOT therapy.  If the patient remains toxic, the treatment needs to be extended.  No more than 10 sessions should be needed to treat; 
   
   
10. Necrotizing Soft-Tissue Infections - HBOT treatments are given at a pressure of 2.0-2.5 atm abs and range from 90 to 120 minutes.  In the initial phase, they should be given twice daily.  Once the patient’s condition has stabilized, treatments may be given on a daily basis until the infection is controlled.  Because of the nature and general progression of these diseases, and because patient response is often slow, an extended course of HBOT therapy may be necessary.  No more than 30 treatments should be needed;
    
    
11. Radiation Necrosis - review is recommended after 60 treatments.  Treatments are usually given daily for 90 to 120 minutes.

Systemic Hyperbaric Oxygen Therapy

Systemic hyperbaric oxygen therapy involves the inhalation of pure oxygen gas while enclosed in a high-pressure chamber (defined as pressure greater than standard atmospheric pressure).  The treatment, given in a clear acrylic chamber, increases the available oxygen to the body by 10 to 20 times.  The therapy works by supersaturating the blood tissues with oxygen. Treatment may be carried out in either a monoplace chamber pressurized with pure oxygen or in a larger, multiplace chamber pressurized with compressed air, in which case the individual receives pure oxygen by mask, head tent, or endotracheal tube.  The number and duration of treatment sessions and the atmospheric pressure during treatment varies depending on the severity of the condition, and the procedures developed by individual hospitals and clinics.  These individual procedures vary widely and have made the evaluation of the efficacy of hyperbaric oxygen therapy difficult. 

Topical Hyperbaric Oxygen Therapy

Topical hyperbaric oxygen therapy involves the delivery of pure oxygen directly to an open, moist wound at a pressure slightly higher than atmospheric pressure.  Much of the research on topical hyperbaric oxygen therapy has focused on chronic wounds arising in diabetic patients – specifically foot wounds responsible for significant mortality and morbidity.    

Definitions

Adjuvant: the use of another form of treatment in addition to the primary therapy

Anemia: a reduction in the number of circulating red blood cells or in the total hemoglobin content of the cells

Atmospheres Absolute (ATA): the combination (or the sum) of the atmospheric pressure and the hydrostatic pressure is called atmospheres absolute (ATA); in other words, the ATA or atmospheres absolute is the total weight of the water and air above us

Carbon Monoxide poisoning: toxicity that results from inhalation of small amounts of carbon monoxide (a poisonous gas) over a long period of time or from large amounts inhaled for a short time, which leads to decreased oxygen delivery to the body

Cerebral Edema: swelling of the brain

Chronic: of a long duration; a disease that persists or progresses over time

Compartmental Syndrome: any condition in which a structure such as a nerve or tendon is being constricted in a space and is no longer able to move freely in the compartment

Decompression Sickness: a condition that develops in divers subjected to rapid reduction of air pressure after coming to the surface following exposure to compressed air

Gangrene: the death of tissue or bone, usually resulting from a deficient or absent blood supply

Gas Embolism: obstruction of a blood vessel by a gas bubble

Ischemia: a local and temporary deficiency of blood supply due to an obstruction of the circulation

Limb Specific Hyperbaric Oxygen: a therapy that involves sealing a person's leg or arm into an airtight container and exposing that limb to pure oxygen greater than one atmosphere of pressure

Mycosis: any condition caused by a fungus

Necrosis: a condition where cells or tissues are dead or dying

Osteomyelitis: inflammation of the bone due to infection

Osteoradionecrosis: death of bone following irradiation

Prophylactic: any agent or treatment that contributes to the prevention of infection or disease

Pyoderma Gangrenosum: a condition of the skin leading to open ulcers

Systemic Hyperbaric Oxygen: a therapy that involves sealing a patient inside a room or container, then exposing the patient to pure oxygen at greater than one atmosphere of pressure

Thermal: related to heat

Topical Hyperbaric Oxygen: a therapy that involves sealing skin wounds under a plastic cover and then exposing the wound to pure oxygen at greater than one atmosphere of pressure; an alternate form of this therapy involves the application of a mist of water droplets to the wound that are saturated with dissolved oxygen

Coding

The following codes for treatments and procedures applicable to this policy are included below for informational purposes.  Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy.  Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services are Medically Necessary:

CPT

HCPCS

ICD-9 Procedure

Revenue Code

ICD-9 Diagnosis

When services are Investigational/Not Medically Necessary:

For the procedure codes listed above, for all other diagnoses not listed; or when the code describes a procedure indicated in the Policy section as investigational/not medically necessary.

When services are also Investigational/Not Medically Necessary:    

HCPCS

ICD-9 Diagnosis

References

Peer Reviewed Publications:

1. Bevers RF, Bakker DJ, Kurth K. Hyperbaric oxygen treatment for haemorrhagic radiation cystitis. Lancet. 1995; 346(8978): 803-805.
2. Bill TJ, Hoard MA, Gampper TJ. Management of facial cutaneous defects, part II: applications of hyperbaric oxygen in otolaryngology head and neck surgery. Otolaryngol Clin North Am. 2001; 34(4):753-766.
3. Cesaro S, Brugiolo A, Faraci M, et al. Incidence and treatment of hemorrhagic cystitis in children given hematopoietic stem cell transplantation: a survey from the Italian association of pediatric hematology oncology-bone marrow transplantation group. Bone Marrow Transplant. 2003; 32(9):925-931.
4. Capelli-Schellpfeffer M, Gerber GS. The use of hyperbaric oxygen in urology. J Urol. 1999; 162(3 Pt 1):647-654.
5. Chong KT, Hampson NB, Corman JM. Early hyperbaric oxygen therapy improves outcome for radiation-induced hemorrhagic cystitis. Urology. 2005; 65(4): 649-53.
6. Cianci P, Sato R. Adjunctive hyperbaric oxygen therapy in the treatment of thermal burns: a review. Burns. 1994; 20(1):5-14.
7. Cotti G, Seid V, Araujo S, et al. Conservative therapies for hemorrhagic radiation proctitis: a review. Rev Hosp Clin Fac Med S Paulo. 2003; 58(5):284-292.
8. Di Piero V, Cappagli M, Pastena L, et al. Cerebral effects of hyperbaric oxygen breathing: a CBF SPECT study on professional divers. Eur J Neurol. 2002; 9(4):419-421.
9. Faglia E, Favales F, Aldeghi A, et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. Diabetes Care. 1996; 19:1338-1343.
10. Feldmeier JJ, Hampson NB. A systematic review of the literature reporting the application of hyperbaric oxygen prevention and treatment of delayed radiation injuries: an evidence based approach. Undersea Hyperb Med. 2002; 29(1):4-30.
11. Gonzalez D. Hyperbaric oxygen therapy for cognitive disorders after irradiation of the brain. Strahlenther Onkol. 2002; 178(4):192-198.
12. Gordillo GM, Sen CK. Revisiting the essential role of oxygen in wound healing. Am J Surg. 2003; 186(3):259-263.
13. Hawkins M, Harrison J, Charters P. Severe carbon monoxide poisoning: outcome after hyperbaric oxygen therapy. British Journal of Anaesthesia. 2000; 84(5):584-586.
14. Heng MC, Harker J, Csathy G, et al. Angiogenesis in necrotic ulcers treated with hyperbaric oxygen. Ostomy Wound Manage. 2000; 46(9):18-28, 30-32.
15. Kalani M, Jorneskog G, Naderi N, et al. Hyperbaric oxygen (HBO) therapy in treatment of diabetic foot ulcers. Long-term follow-up. J Diabetes Complications. 2002; 16(2):153-158.
16. Kochanek PM, Jenkins LW, Edward-Dixon C, Clark RS. HBO: It's not ready for prime time for the treatment of acute central nervous system trauma. Crit Care Med. 2001; 29(4):906-908.
17. Korhonen K. Hyperbaric oxygen therapy in acute necrotizing infections. With a special reference to the effects on tissue gas tensions. Ann Chir Gynaecol. 2000; 89 (Suppl) 214:7-36.
18. Landau Z. Topical hyperbaric oxygen and low energy laser for the treatment of diabetic foot ulcers. Arch Orthop Trauma Surg. 1998; 117(3):156-158.
19. Landau Z, Schattner A. Topical hyperbaric oxygen and low energy laser therapy for chronic diabetic foot ulcers resistant to conventional treatment. Yale J Biol Med. 2001; 74(2):95-100.
20. Leach RM, Rees PJ, Wilmhurst P. ABC of oxygen: hyperbaric oxygen therapy. BMJ. 1998; 317:1140-1143.
21. Marx RE, Johnson RP. Studies in the radiobiology of osteoradionecrosis and their clinical significance. Oral Surg. 1987; 64(4):379-390.
22. McFarlane RM, Wermuth RE. The use of hyperbaric oxygen to prevent necrosis in experimental pedicle flaps and composite skin grafts. Plastic and reconstructive Surgery. 1996; 37(5):422-430.
23. Muth CM, Shank ES. Gas embolism. NEJM. 2000; 342(7):476-482.
24. Myers RA. Hyperbaric oxygen therapy for trauma: crush injury, compartment syndrome, and other acute traumatic peripheral ischemias. Int Anesthesiol Clin. 2000; 38(1):139-151.
25. Niezgoda JA, Cianci P. The effect of hyperbaric oxygen therapy on a burn wound model in human volunteers. Plast Reconstr Surg. 1997; 99(6):1620-1625.
26. Nuthall G, Seear M, Lepawsky M, et al. Hyperbaric oxygen therapy for cerebral palsy: two complications of treatment. Pediatrics. 2000; 106(6):1-3.
27. Ren H, Wang W, Ge Z. Glasgow Coma Scale, brain electric activity mapping and Glasgow Outcome Scale after hyperbaric oxygen treatment of severe brain injury. Chin J Traumatol. 2001; 4(4):239-241.
28. Rockswold SB, Rockswold GL, Vargo JM, et al. Effects of hyperbaric oxygenation therapy on cerebral metabolism and intracranial pressure in severely brain injured patients. J Neurosurg. 2001; 94(3):403-411.
29. Rusnyiak DE, Kirk MA, et al. Hyperbaric oxygen therapy in acute ischemic stroke; results of the hyperbaric oxygen in acute ischemia attack stroke trial pilot study. Stroke. 2003; 34:571-574.
30. Scheinkestel CD, Bailey M, Myles PS, et al. Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomized controlled clinical trial. Med J Aust. 1999; 170(5):203-210.
31. Sen CK, Khanna S, Gordillo G, et al. Oxygen, oxidants, and antioxidants in wound healing: an emerging paradigm. Ann N Y Acad Sci. 2002; 957:239-49.
32. Senior C. Treatment of diabetic foot ulcers with hyperbaric oxygen. J Wound Care. 2000; 9(4):193-197.
33. Shank ES, Muth CM. Decompression illness, iatrogenic gas embolism, and carbon monoxide poisoning: the role of hyperbaric oxygen therapy. Int Anesthesiol Clin. 2000; 38(1):111-138.
34. Tibbles PM, Edelsberg JS. Hyperbaric Oxygen Therapy. NEJM. 1996; 334(25):1642-1648.
35. Van Meter KW.  A systematic review of the application of hyperbaric oxygen in the treatment of severe anemia: an evidence-based approach. Undersea Hyperb Med. 2005; 32(1):61-83.
36. Waisman D, Shupak A, Weisz G, Melamed Y. Hyperbaric oxygen therapy in the pediatric patient: the experience of the Israel Naval Medical Institute. Pediatrics. 1998;102(5):1-9.
37. Weaver LK, Churchill S. Pulmonary edema associated with hyperbaric oxygen therapy. Chest. 2001; 120(4):1407-1409.
38. Weaver LK, Hopkins RO, Chan K, et al. Hyperbaric oxygen for acute carbon monoxide poisoning. N Engl J Med. 2002; 347(14):1057-1067.
39. Wood Z. Hyperbaric oxygen in the management of chronic wounds. Br J Nurs. 2002;11:S16, S18-9, S22-4.

Government Agency, Medical Society, and Other Authoritative Publications: 

1. Agency for Healthcare Research and Quality. Hyperbaric Oxygen Therapy in the Treatment of Hypoxic Wounds and Diabetic Wounds of the Lower Extremities. Technology Assessment 2001.
2. Bennett M, Heard R. Hyperbaric oxygen therapy for multiple sclerosis. Cochrane Database Syst Rev. 2004; (1):CD003057.
3. Bennett MH, Kertesz T, Yeung P. Hyperbaric oxygen for idiopathic sudden sensorineural hearing loss and tinnitus. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD004739.
4. Bennett MH, Trytko B, Jonker B. Hyperbaric oxygen therapy for the adjunctive treatment of traumatic brain injury. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD004609.
5. Bennett M, Jepson N, Lehm JP. Hyperbaric oxygen therapy for acute coronary syndrome. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004818.
6. Bennett MH, Wasiak J, Schnabel A, Kranke P, French C. Hyperbaric oxygen therapy for acute ischaemic stroke. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD004954.
7. Bennett MH, Stanford R, Turner R. Hyperbaric oxygen therapy for promoting fracture healing and treating fracture non-union. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004712.
8. Bennett M, Best TM, Babul S, Taunton J. Hyperbaric oxygen therapy for delayed onset muscle soreness and closed soft tissue injury. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004713.
9. Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C. Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD005005.
10. Bennett M, Feldmeier J, Smee R, Milross C. Hyperbaric oxygenation for tumour sensitisation to radiotherapy. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD005007.
11. Blue Cross Blue Shield Association. Hyperbaric Oxygen Therapy for Wound Healing—Part I. TEC Assessment, 1999; 14 (13).
12. Blue Cross Blue Shield Association. Hyperbaric Oxygen Therapy for Wound Healing—Part II. TEC Assessment, 1999; 14 (15).
13. Blue Cross Blue Shield Association. Hyperbaric Oxygen Therapy for Wound Healing—Part III. TEC Assessment, 1999; 14 (16).
14. Centers for Medicare and Medicaid Services. National Coverage Determination for Hyperbaric Oxygen Therapy. NCD #20.29. Effective April 1, 2003. Available at:    http://www.cms.hhs.gov/mcd/index_list.asp?list_type=ncd. Accessed on March 6, 2007.
15. Centers for Medicare and Medicaid Services. National Coverage Determination for Treatment of Decubitus Ulcers. NCD #270.4. Effective date not posted.  Available at:  http://www.cms.hhs.gov/mcd/index_list.asp?list_type=ncd. Accessed on March 6, 2007.
16. Coulthard P, Esposito M, Worthington HV, Jokstad A. Interventions for replacing missing teeth: hyperbaric oxygen therapy for irradiated patients who require dental implants. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD003603.
17. Denton AS, Maher EJ. Interventions for the physical aspects of sexual dysfunction in women following pelvic radiotherapy. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD003750.
18. Hayes, Inc. Hayes Medical Technology Directory.  Topical Oxygen Therapy for Chronic Wound Healing. Lansdale, PA: Hayes, Inc.; January 2002. Search updated February 9, 2007.
19. Hayes, Inc. Hayes Medical Technology Directory. Hyperbaric Oxygen Therapy for Carbon Monoxide Poisoning. Lansdale, PA: Hayes, Inc.; May 2002. Search updated December 6, 2006.
20. Hayes, Inc. Hayes Medical Technology Directory. Hyperbaric Oxygen Therapy for Burns, Infections, and Wounds. Lansdale, PA: Hayes, Inc.; May 2002. Search updated December 5, 2006.
21. Hayes, Inc. Hayes Medical Technology Directory. Hyperbaric Oxygen Therapy for Radiation Injuries. Lansdale, PA: Hayes, Inc.; December 2003. Search updated January 26, 2007.
22. Juurlink DN, Buckley NA, Stanbrook MB, Isbister GK, Bennett M, McGuigan MA. Hyperbaric oxygen for carbon monoxide poisoning. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD002041.
23. Kranke P, Bennett M, Roeckl-Wiedmann I, Debus S. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database of Systematic Reviews 2004, Issue 1. Art. No.: CD004123.
24. National Institutes of Health Consensus Development Conference Statement: Oral Complications of Cancer Therapies: Diagnosis, Prevention, and Treatment. 1989 (update 1995). Bethesda, MD.
25. Phillips JS, Jones SEM. Hyperbaric oxygen as an adjuvant treatment for malignant otitis externa. Cochrane Database of Systematic Reviews 2005, Issue 2. Art. No.: CD004617
26. Undersea and Hyperbaric Medical Society. Feldmeier JJ, Hopf HW, Warriner RA 3rd, et al. UHMS position statement: Topical oxygen for chronic wounds. Undersea Hyperb Med. 2005; 32:157-168.
27. Undersea and Hyperbaric Medical Society. Bennett M, Heard R. . UHMS position statement: Treatment of multiple sclerosis with hyperbaric oxygen therapy. Undersea Hyperb Med. 2001; 28(3):117-122.
28. Villanueva E, Bennett MH, Wasiak J, Lehm JP. Hyperbaric oxygen therapy for thermal burns. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004727.

Web Sites for Additional Information

1. National Library of Medicine. Medical Encyclopedia. Hyperbaric oxygen therapy. Available at:  http://www.nlm.nih.gov/medlineplus/ency/article/002375.htm.  Accessed March 06, 2007.

Index

Policy History