Medicare Advantage

Medical Policy

Notification

Topical Oxygenation

Notification Issue Date: 12/1/2025 12:00 PM

Effective 01/01/2026, the Company has determined that it is no longer necessary for the following policy to remain active due to minimal reported utilization, therefore, Policy #MA07.011a Topical Oxygenation will be archived. 

Title:

Topical Oxygenation

Policy #:

MA07.011a

Policy

Topical oxygenation is considered experimental/investigational and, therefore, not covered because the safety and/or effectiveness of this service cannot be established.

Guidelines

This policy is consistent with Medicare’s coverage determination. The Company’s payment methodology may differ from Medicare.

BENEFIT APPLICATION

Subject to the terms and conditions of the applicable Evidence of Coverage, topical oxygenation is not eligible for payment under the medical benefits of the Company’s Medicare Advantage products because the service is considered experimental/investigational and, therefore, not covered.

Services that are experimental/investigational are excluded for the Company’s Medicare Advantage plans. Therefore, they are not eligible for reimbursement consideration.

Description

Topical oxygenation, also referred to as topical hyperbaric oxygenation, is a technique that delivers 100 percent oxygen directly to an open, moist wound at a pressure slightly higher than atmospheric pressure. The theory behind this therapy is that the high concentrations of oxygen diffuse directly into the wound to increase the local cellular tension, which in turn promotes wound healing. During topical oxygenation, a device surrounds the wound area (usually an extremity), and oxygen is delivered under pressure from a source such as a conventional oxygen tank. This therapy has been promoted as a treatment for diabetic and venous stasis ulcers, burns, amputations, infected wounds, frostbite, gangrenous lesions, and skin graft sites. Topical oxygenation may be performed in the inpatient, home, clinic, or office setting. Typically, the therapy is offered for 90 minutes per day for 4 consecutive days. After a 3-day break, the cycle may be repeated.

In 2021, Thanigaimani et al. performed a meta-analysis on six randomized controlled trials examining topical oxygenation in individuals with diabetic foot ulcers (DFU). The authors concluded that based on the analysis, topical oxygen could be considered for the treatment of nonhealing neuropathic DFU. However, they also conclude that their findings should be “interpreted cautiously” due to heterogeneity between the studies with differences in treatment and follow-up along with the studies having small sample sizes. The authors performed a funnel plot using Egger’s test, which suggested that there may be publication bias due to asymmetry in the observed outcomes. This evidence supports the current position.

In 2023, Sykorova et al. performed a review of the topic and discussed the limitations when comparing the various evidence of topical oxygen therapy. Studies are often not double blinded or placebo-controlled and there is heterogeneity in the treatment protocols along with the etiologies of the wounds studied, which prevents comparisons between studies. The investigators suggest that more research is necessary on the topic to understand the impact of oxygen therapy on specific types of wounds.

Topical oxygenation has sometimes been confused with hyperbaric oxygen therapy (HBO), which involves the inhalation of 100 percent oxygen at an elevated (i.e., greater than sea-level) atmospheric pressure, typically between 2 and 3 atmospheres absolute (ATA). The delivery system for HBO uses either a full-body monoplace (single-person) chamber or a full-body multiplace (multiple-person) chamber. In monoplace chambers, the entire chamber is pressurized with 100 percent oxygen to the desired ATA. Multiplace chambers, which can accommodate two to 12 individuals, are pressurized using compressed air; the individuals breathe 100 percent oxygen via mask, head tent, or endotracheal tube.

Clinical efficacy of topical oxygen has not been established.

References

Camporesi EM, ed. Undersea and Hyperbaric Medical Society. Hyperbaric Oxygen Therapy: A Committee Report. Kensington, MD; 1996.

Copeland K, Purvis AR. A retrospective chart review of chronic wound patients with topical oxygen therapy. Advances in Wound Care. 2017; 6(5):143-152.

Du X, Zhang X, Liu J, Wang Z. (2024). Effects of Oxygen Therapy on Patients with a Chronic Wound: A Systematic Review and Meta-analysis. Advances in Skin & Wound Care. 2024;37(5):1-9.

Edsberg LE, Brogan MS, Jaynes CD, et al. Topical hyperbaric oxygen and electrical stimulation: exploring potential synergy. Ostomy Wound Manage. 2002;48(11):42-50.

Feldmeier JJ, Hopf HW, Warriner RA 3rd, et al. UHMS position statement: topical oxygen for chronic wounds. Undersea Hyperb Med. 2005;32(3):157-168.

Heng MC, Harker J, Bardakjian VB, et al. Enhanced healing and cost-effectiveness of low-pressure oxygen therapy in healing necrotic wounds: a feasibility study of technology transfer. Ostomy Wound Manage. 2000;46(3):52-60,62.

Heng MC, Harker J, Csathy G, et al. Angiogenesis in necrotic ulcers treated with hyperbaric oxygen. Ostomy Wound Manage. 2000;46(9):18-28,30-2.

Heng MC. Topical hyperbaric therapy for problem skin wounds. J Dermatol Surg Oncol. 1993;19(8):784-793.

Heng MC, Pilgrim JP, Beck FW. A simplified hyperbaric oxygen technique for leg ulcers. Arch Dermatol.1984;120(5):640-645.

Hunt S. Topical oxygenation therapy in wound care: are patients getting enough? Br J Nurs. 2017;26(15):S28-S36.

Kalliainen LK, Gordillo GM, Schlanger R, et al. Topical oxygen as an adjunct to wound healing: a clinical case series. Pathophysiology. 2003;9(2):81-87.

Kaufman H, Gurevich M, Tamir E, et al. Topical oxygen therapy stimulates healing in difficult, chronic wounds: a tertiary centre experience. J Wound Care. 2018;27(7):426-433.

Kleinman Y, Cahn A. Conservative management of Achilles tendon wounds: results of a retrospective study. Ostomy Wound Manage. 2011;57(4):32-40.

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.

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.

Landau Z, Sommer A, Miller EB. Topical hyperbaric oxygen and low-energy laser for the treatment of chronic ulcers. Eur J Intern Med. 2006;17(4):272-275.

Leslie CA, Sapico FL, Ginunas VJ, Adkins RH. Randomized controlled trial of topical hyperbaric oxygen for treatment of diabetic foot ulcers. Diabetes Care. 1988;11(2):111-115.

Nataraj M, Maiya AG, Karkada G, et al. Application of topical oxygen therapy in healing dynamics of diabetic foot ulcers - A systematic review. Rev Diabet Stud. 2019;15:74-82.

Sen CK, Khanna S, Gordillo G, et al. Oxygen, oxidants, and antioxidants in wound healing: an emerging paradigm. Ann N Y Acad Sci. 2002;957:239-249.

Sýkorová M, Moffatt CJ, Stentiford N, et al. Topical oxygen therapy and singlet oxygen in wound healing: A scoping review. Int Wound J. 2024;21(4):e14846.

Thanigaimani S, Singh T, Golledge J. Topical oxygen therapy for diabetes-related foot ulcers: A systematic review and meta-analysis. Diabet Med. 2021;38(8):e14585.

Undersea and Hyperbaric Medical Society (UHMS). Indications for hyperbaric oxygen therapy. [UHMS Web site]. Available at: https://www.uhms.org/resources/featured-resources/hbo-indications.html. Accessed June 11, 2024.

Vas P, Rayman G, Dhatariya K, et al. Effectiveness of interventions to enhance healing of chronic foot ulcers in diabetes: a systematic review. Diabetes Metab Res Rev. 2020;36(suppl 1):e3284.

Yu J, Lu S, McLaren AM, et al. Topical oxygen therapy results in complete wound healing in diabetic foot ulcers. Wound Repair Regen. 2016;24(6):1066-1072.

Coding

CPT Procedure Code Number(s)

THE FOLLOWING CODE IS USED TO REPRESENT TOPICAL OXYGENATION WHEN PERFORMED AS A PROFESSIONAL SERVICE:

99199

ICD - 10 Procedure Code Number(s)

N/A

ICD - 10 Diagnosis Code Number(s)

N/A

HCPCS Level II Code Number(s)

THE FOLLOWING CODES ARE CONSIDERED EXPERIMENTAL/INVESTIGATIONAL:

A4575 Topical hyperbaric oxygen chamber, disposable

E0446 Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories

Revenue Code Number(s)

N/A

MPMiscCodesNarrativesPub

Coding and Billing Requirements

Cross Reference

Policy History

Revisions From MA07.011a:

06/26/2024	This policy has been reviewed and reissued to communicate the Company's continuing position on topical oxygenation.
01/01/2024	Effective 01/01/2024 this policy applies to New Jersey Medicare Advantage (MA) lines of business.
05/03/2023	The policy has been reviewed and reissued to communicate the Company's continuing position on topical oxygenation.

06/29/2022	The policy has been reviewed and reissued to communicate the Company's continuing position on topical oxygenation.
06/30/2021	The policy has been reviewed and reissued to communicate the Company's continuing position on topical oxygenation.
10/21/2020	The policy has been reviewed and reissued to communicate the Company's continuing position on topical oxygenation.
06/05/2019	The policy has been reviewed and reissued to communicate the Company’s continuing position on topical oxygenation.
05/23/2018	The policy has been reviewed and reissued to communicate the Company’s continuing position on topical oxygenation.
06/07/2017	This policy has been reissued in accordance with the Company's annual review process.
03/16/2016	The policy has been reviewed and reissued to communicate the Company’s continuing position on Topical Oxygenation.
04/08/2015	The policy has been reviewed and reissued to communicate the Company’s continuing position on Topical Oxygenation. The CPT code 99199 added to policy.

Revisions From MA07.011:

01/01/2015

This is a new policy.

Version Effective Date:

1/1/2026

Version Issued Date:

4/8/2015

Version Reissued Date:

6/26/2024