Hyperbaric Oxygen Therapy for Posttraumatic Stress Disorder and Traumatic Brain Injury
Clinical Determination and Indication Number: 00075
Original Effective Date: July 1, 2026
Last Review Date: July 1, 2026
I. Disclaimer
This document is intended to be used as a reference for non-VA providers and not intended to replace clinical judgment when determining care pathways. These guidelines do not guarantee benefits or constitute medical advice.
II. Clinical Determinations and Indications
- Indications for Hyperbaric Oxygen Therapy
- Hyperbaric oxygen therapy (HBOT) is considered investigational and experimental and therefore not medically necessary and not covered for the following indications, including but not limited to:
- Posttraumatic stress disorder (PTSD)
- Traumatic brain injury (TBI)
- There is insufficient evidence from peer-reviewed medical literature to support the safety and efficacy of this treatment.
III. Background and Supporting Information
The following information is for reference purposes only in accordance with the medical benefits package outlined in 38 C.F.R. § 17.38 (b). Each subsection supports VA’s determinations for medical necessity and alignment with generally accepted standards of medical practice.
- Background Information
Hyperbaric oxygen therapy (HBOT) is a medical treatment in which a patient breathes 100% pure oxygen inside a specially designed pressurized chamber. The air pressure in the chamber is typically two to three times higher than normal atmospheric pressure, allowing the lungs to absorb significantly more oxygen. This elevated oxygen level is then circulated throughout the body with the intent to enhance healing, combat infections, and support tissue repair. Treatment sessions generally last between 30 and 120 minutes and are most often performed on an outpatient basis. The number and duration of sessions depend on the severity and nature of the condition being treated. While HBOT is widely used for a range of medical conditions, including wound healing and decompression sickness, it has not been shown to be effective in treating posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI).
Posttraumatic stress disorder is a mental health condition that can develop after experiencing or witnessing a traumatic event such as combat, assault, or a serious accident. It is characterized by symptoms including intrusive memories, nightmares, flashbacks, avoidance of trauma reminders, heightened arousal, and negative changes in mood and cognition. The primary treatment approach for PTSD involves trauma-focused psychotherapies, such as cognitive processing therapy (CPT), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR). These evidence-based therapies are designed to help individuals process and reframe traumatic memories, reduce distress, and improve daily functioning.
Hyperbaric oxygen therapy has been explored as a potential intervention for PTSD. However, it is not currently recommended for PTSD. According to the U.S. Department of Veterans Affairs (VA) and Department of Defense (DoD) clinical practice guidelines, there is insufficient evidence to support its effectiveness in treating PTSD. As a result, HBOT is not included among the approved or recommended treatments for PTSD.
Traumatic brain injury is a serious condition caused by a sudden blow or jolt to the head, or by an object penetrating the skull. Traumatic brain injuries can range from mild concussions to severe brain damage. Symptoms may include headaches, cognitive impairments, behavioral changes, and altered sensory perception. Treatment for TBI typically begins with stabilizing the patient and managing acute symptoms. This is followed by a tailored rehabilitation plan that may include physical therapy, occupational therapy, speech-language therapy, and cognitive rehabilitation to address specific deficits. When PTSD and TBI are both present, integrated treatment plans are developed to address both the psychological and neurological dimensions of recovery.
Hyperbaric oxygen therapy has been explored as a potential treatment for TBI. However, it is not approved by the U.S. Food and Drug Administration (FDA) for the treatment of TBI and the overall scientific evidence remains inconclusive and lacks consistency.
- Research, Clinical Trials, and Evidence Summaries
Hyperbaric oxygen therapy has been included in some trials as a treatment for PTSD and TBI; however, following careful review of the Clinical Practice Guidelines it is not recommended as a form of treatment.
The 2023 VA DoD Clinical Practice Guideline for Management of Posttraumatic Stress Disorder and Acute Stress Disorder does not recommend for nor against the use of HBOT due to insufficient evidence.
The 2021 VA DoD Clinical Practice Guideline for the Management and Rehabilitation of Post-acute Mild Traumatic Brain Injury explicitly advises against the use of HBOT for the treatment of mild TBI.
- Medicare Coverage Determinations
Available Medicare national and local coverage determinations are listed below as a resource. VA and Medicare are governed by separate laws and regulations; thus, VA coverage determinations may be different.
| NCD Number | Name | Effective Date |
|---|---|---|
| 20.29 | Hyperbaric Oxygen Therapy | 04/03/2017 |
| LCD Number | Contractor | Original/Revision Effective Date |
|---|---|---|
| N/A | N/A | N/A |
- NCD: National Coverage Determination
- LCD: Local Coverage Determination
- TRICARE Policy Manual
Available TRICARE coverage determinations are listed below as a resource. VA and TRICARE are governed by separate laws and regulations; thus, VA coverage determinations may be different.
TRICARE Policy Manual 6010.63-M, Chapter 7, Section 20.1
- Hyperbaric oxygen therapy for traumatic brain injury (TBI) is unproven.
- Health Care Procedural Coding Information
The following CPT®/HCPCS codes listed in this section are provided for informational purposes only. Inclusion or exclusion of a code does not constitute or imply VA coverage or provider reimbursement. The list of codes may not be all-inclusive since the American Medical Association (AMA) and Centers for Medicare & Medicaid Services (CMS) code updates may occur more frequently than CDI updates. Please refer to section II.a. in this document to review indications and clinical criteria for medical necessity.
The following CPT codes are considered not medically necessary/not covered due to VA exclusion or because they are considered investigational and experimental. Additional codes may also apply.
| CPT Code | Description |
|---|---|
| 99183 | Physician attendance and supervision of hyperbaric oxygen therapy, per session |
| G0277 | Hyperbaric oxygen under pressure, full body chamber, per 30-minute interval |
CPT copyright © 2026 American Medical Association. All rights reserved.
IV. Definitions
| Term | Definition |
|---|---|
| Cognitive processing therapy | A specific type of cognitive behavioral therapy that has been effective in reducing symptoms of posttraumatic stress disorder that have developed after experiencing a variety of traumatic events including child abuse, combat, rape and natural disasters |
| Eye movement desensitization and reprocessing | A structured therapy that encourages the patient to briefly focus on the trauma memory while simultaneously experiencing bilateral stimulation (typically eye movements), which is associated with a reduction in the vividness and emotion associated with the trauma memories |
| Hyperbaric oxygen therapy | A medical treatment in which a patient breathes 100% pure oxygen inside a specially designed pressurized chamber, increasing the absorption of oxygen significantly than it would under normal conditions |
| Neuroplasticity | The ability of the nervous system to change its activity in response to intrinsic or extrinsic stimuli by reorganizing its structure, functions, or connections after injuries, such as a stroke or traumatic brain injury |
| Posttraumatic stress disorder | A mental health condition that can develop after experiencing or witnessing a traumatic event such as combat, assault, or a serious accident. It is characterized by symptoms including intrusive memories, nightmares, flashbacks, avoidance of trauma reminders, heightened arousal, and negative changes in mood and cognition |
| Traumatic brain injury | A serious condition caused by a sudden blow or jolt to the head, or by an object penetrating the skull. Traumatic brain injuries can range from mild concussions to severe brain damage, and symptoms may include headaches, cognitive impairments, behavioral changes, and altered sensory perception |
V. References
(Reference Normal)
MCG Health. (2025, January 25). Hyperbaric Oxygen. Ambulatory Care. 27th Edition.
Medicare Coverage Database (n.d.). Retrieved June 03, 2025.
VI. CDI History/Revision Information
| Date | Summary of Updates |
|---|---|
| 07/01/2026 | New CDI created describing not medically necessary indications |