Chronic refractory osteomyelitis persists or recurs following appropriate interventions. These interventions include the prolonged use of antibiotics, drainage of the abscess, immobilization of the affected extremity, and surgical debridement with removal of as much of infected bone matrix as possible. Medicare may cover the adjunctive use of HBO therapy for chronic refractory osteomyelitis that has been shown to be unresponsive to conventional medical and surgical management.
HBO therapy is an adjunctive therapy used with the appropriate antibiotics and surgical debridement to eliminate the necrotic bone acting as a foreign body. When the site of the bone infection is not amenable to debridement or resection, HBOT may be indicated to enhance systemic therapy though is not indicated as primary therapy alone.
HBO treatments are usually delivered daily for a period of 90-120 minutes and it is not unusual to receive daily treatments following major debridement surgery. The usual course of therapy lasts 4-6 weeks with daily sessions lasting 90-120 minutes up to a maximum of 60 treatments within a 12 month period as designated by the CMS pre-authorization project. Additional treatments may be considered reasonable and necessary on redetermination.
Hyperbaric oxygen therapy is not considered medically reasonable or necessary for treatment of osteomyelitis of small, solid or non-weight-bearing bones of the forefoot and fingers (metatarsal bones, phalanges) which are more effectively treated with debridement and receive minimal benefit from HBOT due to limited perfusion. HBOT is not considered reasonable and necessary for primary or non-adjunctive treatment of chronic osteomyelitis.