UHMS and the US Wound Registry discuss Medicare reimbursement issues

The Hyperbaric Oxygen Therapy Registry (HBOTR) has released an important paper detailing its work in Medicare reimbursement issues.

“Rapid analysis of hyperbaric oxygen therapy registry data for reimbursement purposes,” a technical paper by Caroline E. Fife, Helen Gelly, David Walker and Kristen Allison Eckert is available as an epub-ahead-of-print download to members of the Undersea and Hyperbaric Medical Society. Just log in and go to:


Jointly sponsored by the UHMS and the US Wound Registry (USWR), the HBOTR recently provided national data quickly to the RUC on thousands of patients who underwent HBO2 in order to help establish a fair analysis of the physician work of hyperbaric chamber supervision.

Medicare reimbursement rates for all physician services are established via a complex methodology utilizing data provided by the American Medical Association (AMA)/Specialty Society Relative Value Scale Update Committee (RUC), which values the “relative work” and practice expense of CPT codes and makes recommendations regarding valuations to the Centers for Medicare and Medicaid Services (CMS).

The authors note: “It is vital that hyperbaric practitioners engage in registry submission if they are to survive the titanic shift in healthcare payment reform under MACRA (Medicare Access & Chip Reauthorization Act of 2015).”

Participation in a Qualified Clinical Data Registry (QCDR) can satisfy the requirement for specialty registry participation under “Meaningful Use” of an Electronic Health Record and counts as 15% of the provider’s total score in MACRA’s Merit Based Incentive Payment System (MIPS). Hyperbaric practitioners who report quality measures through the HBOTR can earn bonus points for the Quality Reporting portion of MIPS (50% of the total score), particularly if they report safety, appropriate use, or outcome quality measures. While no such hyperbaric measures are available in the Physician Quality Reporting System, the UHMS developed hyperbaric safety, outcome, and appropriate use measures in partnership with the USWR, which can be reported through that QCDR and whose data become part of the HBOTR.

To read the paper in its entirety, go to: https://www.uhms.org/publications/uhm-journal/uhm-journal-ahead-of-print.html

Enjoy the fruits of your LABOR with 20% off registration on all UHMS online educational programs August 29-September 5, 2016

Work hard. Save now.

You work hard, and the UHMS would like to reward you with 20% off all registrations August 29-September 5, 2016, on any educational programs at the UHMS Online Continuing Educational Portal.  Currently, there are more than 14 programs to choose from that include Fast-Tracks, Journal-Based CME and longer Symposiums on hyperbaric medicine, diving medicine and wound care.

Benefits of fulfilling your CME/CEU requirements with UHMS Online Education:

  • Work at your own pace and start and stop as you like
  • Receive CME/CEU credit immediately upon completion of the program
  • Access the program anywhere there is an internet connect and supported browser
  • All programs are accredited by UHMS for Physician CME, NBDHMT Category A/B, Nursing/RRT contact hours and MOC for ABPM Physicians
  • Up-to-date content from internationally recognized expert faculty
  • UHMS Members receive significant discounts up to 40%
  • Receive your “12 for 12” recommended hours for less than $150!

Create a free account today!  

Already have an account?  Login any time to register for any of our educational programs!


Symposium on Hyperbaric Medicine and Wound Management (20 CME/CEU Hours)
Click here to access and purchase the course now

Mayo Clinic Hyperbaric Medicine 2015 (15.50 CME/CEU hours)
Click here to access and purchase the course now

UHM Journal-Based CME Volume 42, Issue 1 (2 CME/CEU hours)
Click here to access and purchase the course now

UHM Journal-Based CME Volume 42, Issue 2  (2 CME/CEU hours)
Click here to access and purchase the course now

UHM Journal-Based CME Volume 42, Issue 3  (2 CME/CEU hours)
Click here to access and purchase the course now

UHM Journal-Based CME Volume 42, Issue 4  (2 CME/CEU hours)
Click here to access and purchase the course now

UHM Journal-Based CME Volume 42, Issue 5  (2 CME/CEU hours)
Click here to access and purchase the course now

UHM Journal-Based CME Volume 42, Issue 6  (2 CME/CEU hours)
Click here to access and purchase the course now

UHM Journal-Based CME Volume 43, Issue 1  (2 CME/CEU hours)
Click here to access and purchase the course now

Fast Track 1: Best Practices in Hyperbaric Medicine and Wound Care: GRADE, CPG’s, Future Research (4 CME/CEU hours)
Click here to access and purchase the course now

Fast Track 2: Wound Care: NPWT, Surgical Treatment of Wounds, Case Studies (4.5 CME/CEU hours)
Click here to access and purchase the course now

Fast Track 3: Diver Fatalities, Fitness to Dive, Stresses in Diving and Case Studies (4.5 CME/CEU hours)
Click here to access and purchase the course now

Fast Track 4: Hyperbaric Facility Operations (Staffing roles, UHMS Accreditation, Practice Models and NFPA Update) (4.5 CME/CEU hours)
Click here to access and purchase the course now

Fast Track 5: Diabetic Foot Ulcers (DFU), Venous Ulcers and Fluorescence Vascular Angiography (FVA) in Hyperbaric Medicine and Wound Care (5.5 CME/CEU hours)
Click here to access and purchase the course now

Accreditation Statement:
The Undersea and Hyperbaric Medical Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

*Hours may vary depending on accrediting organization.  Please see table of contents for full designation statements.  Registration costs vary for Associate Members, Regular Members and Non-Members.

Be safe and enjoy this Labor Day!

CUHMA registration is open

Important Notice from CUHMA regarding online meeting registration

It has come to our attention over the past few days that a glitch recently developed in the registration page on our website for the 7th CUHMA Annual Scientific Meeting.  Several people who were trying to register either received a terminal ‘error’ message when they tried to pay, or believe that they have registered and paid, but nothing came through on the website.

Our IT Manager has now corrected the glitch. Although it appears to have affected mainly American registrants, we are uncertain how widespread the problem was. We are therefore, asking anyone who either received the error message, OR did not receive an e-mail confirming their registration for the CUHMA conference, to please contact me at: drdeb1@ns.sympatico.ca. As a result of this glitch, the ASM Planning Committee has decided to extend the 10% early-bird discount on registration for this year’s conference until 27 Aug 2016.

This year’s conference will be held in Vancouver, BC, from 9-11 Sept 2016 at Simon Fraser University’s Segal Building, Harbour Centre.  Please go to our new website: www.cuhma.ca for registration.  Additional information includes:

Conference – This year’s conference will include both a Hyperbaric Medicine Day on Sat, 10 Sept 2016 and a Diving Medicine Day on Sun, 11 Sept 2016.  Morning and afternoon refreshment breaks and lunch are included with registration for the conference.  The final Scientific Program is now available on-line.  Block-bookings for discounted hotels in the area have now expired, however a list of hotels within 10 min walking distance of the conference venue are still listed on our website. In addition to the early-bird discount, current members of CUHMA receive an additional 10% discount on registration.  If you decide to join CUHMA at the time of registration, you will be entitled to this additional discount; membership can be applied for on-line at the same time as registration for the conference.

HETS (Hyperbaric Emergency Team Simulation) Pre-course – Scheduled for Fri, 9 Sept 2016, ‘early-bird’ registration has also been extended to 27 Aug 2016.  This intensive course is designed to meet the demands for certification and Continuing Professional Development in Hyperbaric Medicine. The new Diploma in Hyperbaric Medicine available shortly from the Royal College of Physicians and Surgeons of Canada requires the use of simulation in training.  The HETS course has now been approved for 22.5 MOC Section 3 (FRCPC) and 7.5 Mainpro+ (CCFP) study credits.  The course involves hands-on participation, decision-making skills and expert debriefing for multiple complex scenarios that cover key areas of expertise for both multi-place and mono-place hyperbaric chambers.  Watch an exciting teaser-trailer video of what to expect at:  https://cuhma.ca/events/hets-teaser-trailer. For more information and registration, click: https://cuhma.ca/events/hyperbaric-emergency-team-simulation. The course will be conducted at CESEI, Vancouver General Hospital (not the SFU Harbour Centre conference site).

Tour of Shearwater Research – A unique opportunity to learn more about the development and manufacturing of dive computers, Shearwater Research is offering a tour of their new facility in Richmond, BC on Fri, 9 Sept 2016 from 13.00 – 15.30h. There is no charge for this tour, and transportation will be provided to and from the Segal Building.

Welcome Reception – Hosted by Simon Fraser University at the beautiful Simon Fraser Observatory on Fri, 9 Sept 2016; a full buffet dinner is included courtesy of our hosts. Transportation to and from the Observatory will be provided from the Segal Building Harbour Centre conference site, departing at 18.30h.  The Welcome Reception is included with conference registration, but please indicate during registration whether or not you plan to attend so that we can plan for transportation accordingly.

Dinner & Awards Banquet – Always a highlight of each year’s scientific conference, this event will be held at the Segal Building conference site on Sat, 10 Sept 2016 from 19.00 – 22.00h.  The cost will be $65.00 per person for a unique buffet-style dinner, including wine and door prizes.  A wide variety of starters, entrees and desserts will be available.

Hope to see all of you in Vancouver!

Best regards,

Debbie L. Pestell, MD
Planning Committee, CUHMA 2016 Vancouver
Board of Directors, 2016 President-elect

UHMS Seeks Grant Funding for Scientific Writer

Undersea and Hyperbaric Medical Society grant proposal request for part-time scientific writer 


The Undersea and Hyperbaric Medical Society (UHMS) is seeking funding to contract with a scientific writer to work with the various UHMS committees for the purpose to assist them in authoring works in the fields of undersea and hyperbaric medicine such as: position letters and statements, creating commentary on published works, gathering and creating metadata, etc. This resource is expected to have a positive material effect for the membership.


The Undersea and Hyperbaric Medical Society (UHMS) is an international scientific organization which was founded in 1967 to foster exchange of data on the physiology and medicine of commercial and military diving. Over the intervening years, the interests of the Society have enlarged to include clinical hyperbaric oxygen therapy. The society has grown to over 2,000 members and has established the largest repository of diving and hyperbaric research collected in one place. Clinical information, an extensive bibliographic database of thousands of scientific papers, as well as books, and technical reports which represent the results of over 100 years of research by military and university laborato­ries around the world are contained in the UHMS Schilling Library, holdings are now part of the Duke University Library, Durham, NC. The results of ongoing research and clinical aspects of undersea and hyperbaric medicine are reported annually at scientific meetings and in Undersea and Hyperbaric Medicine published bi-monthly.

The UHMS is a nonprofit 501(c)3 corporation. The board of directors (board), elected by the membership oversees the organization’s mission and adherence to its bylaws. The president of the board is responsible for choosing the UHMS committees’ chairs. There are numerous standing committees and a few ad hoc ones as well. The board hires the executive director who oversees the organization and executes the policy of the board.

The Society shall be international in scope. Its primary purposes shall be:

  1. to provide a forum for professional scientific communication among individuals and groups involved in basic and applied studies concerned with life sciences and human factors aspects of the undersea environment and hyperbaric medicine.
  2. to promote cooperation between the life sciences and other disciplines concerned with undersea activity and hyperbaric medicine.
  3. to develop and promote educational activities and other programs, which improve the scientific knowledge of matters related to undersea and hyperbaric environments and the accepted applications of hyperbaric oxygen therapy for the membership, as well as physicians and allied health professionals, divers, diver technicians and the public at large.
  4. to provide a source of information and support in the clinical practice of hyperbaric medicine and to stay abreast of legislative, legal, and regulatory changes in the field.
  5. to provide a means by which hyperbaric facility directors/owners will have an opportunity to request an accreditation survey of their facility for safety, staffing and verifying the adequacy of the professional medical application of hyperbaric therapy.

The UHMS has long been regarded as the pre-eminent scientific organization in the fields of undersea and hyperbaric medicine. The UHMS continues to shoulder the burden of producing the scientific rationale that allows the field to progress. However, over the past few years, globally the fields and medicine in general have been beleaguered with regulatory changes and the UHMS is underfunded to be able to adequately respond with the scientific information needed for each issue being presented.

The UHMS can be a central force, as it has in the past for positive change but needs additional and external funding to accomplish this goal.


The UHMS has historically been the organization regulatory bodies have referenced including the Centers for Medicare and Medicaid Services (CMS) and the Food and Drug Administration (FDA), particularly with regard to the scientifically backed indications for hyperbaric oxygen therapy (HBO2).

This goes back to the need for meticulous scrutiny of emerging clinical applications of HBO2, the UHMS established the Hyperbaric Oxygen Therapy Committee in 1976. The committee was charged with the responsibility of continuously reviewing the research and clinical data and rendering recommendations regarding clinical efficacy and safety of HBO2. To achieve this goal, the multidisciplinary committee is comprised of practitioners and scientific investigators.

Since, 1976, the committee has met annually to review research and clinical data. From the twenty-eight indications for which third party reimbursement was recommended in the 1976 and 1979 reports, the number of approved indications has been refined to fourteen in the 2014 report. These indications are those for which in vitro and in vivo pre-clinical research data as well as extensive positive clinical experience and study have become convincing.

Evidence considered by the committee includes sound physiologic rationale; in vivo or in vitro studies that demonstrate effectiveness; controlled animal studies; prospective controlled clinical studies; and extensive clinical experience from multiple, recognized hyperbaric medicine centers.

The committee also reviews cost effectiveness and has established guidelines for each entity. Results show that, in addition to its clinical efficacy, HBO2 therapy yields direct cost savings by successfully resolving a high percentage of difficult and expensive disorders, thereby minimizing prolonged healthcare interventions.

The committee recommends third party reimbursement of HBO2 for the disorders included in the accepted conditions category. Currently, most insurance carriers have established HBO2 reimbursement policies.

The need to support the field with scientific literature is unprecedented at this point in the fields’ existence.

Specifically, the major issues being experienced at this point are third party payor challenges to the UHMS approved indications including these listed below.

  • Misinterpretation of UHMS diagnoses which do not meet the intent of the author(s)
  • Deletion of indications potentially without proper analysis
  • Deletion of indications as a result of a poorly defined crosswalk between ICD-9 and ICD-10


To address the challenges the UHMS is seeking to fund a scientific writer to assist the UHMS committee chairs in authoring scientific works, i.e. position statements, letters, etc. that will have a positive and meaningful impact on individuals participating in the fields of undersea and hyperbaric medicine.

The program will begin immediately as funding comes into the program for the scientific writer and will end when the funding runs out. This position is viewed as being one that could and should go into perpetuity and therefore the UHMS will be seeking to fund the need into the future.

When funded, the scientific writer will be assigned to the highest priority items which at this point are:

  • Assist in authoring a position on the elimination of radiation codes and compromised flap in the process of the ICD-9 to ICD-10 transition
  • Compiling scientific literature and performing analysis on the indications most at risk for challenge by third-party payors


The cost of the position is estimated to be eighty thousand dollars – US ($80,000.00) annually for approximately 1000 hours.

100% of the contributions going to this restricted grant request will be used for the project as it is described.


Individuals or organizations wanting to contribute to this specific grant, please mail funds to the UHMS office specifically as described below. Checks will be made out to the UHMS and in the Memo line please write Scientific Writer Fund.

Undersea and Hyperbaric Medical Society
Scientific Writer Grant
631 US Highway 1
Suite 307
North Palm Beach, FL 33408

If you have any questions, please contact John S. Peters, Executive Director UHMS.

Contributions to the Undersea and Hyperbaric Medical Society—a 501(c)(3) charitable organization—are tax-deductible for federal income tax purposes as provided under the Internal Revenue Code.

Donors should consult their own tax advisor regarding the specific deductibility of their charitable contributions.

Spring Pressure 2016 is posted

It’s all good. It’s all new. 

It’s ready for you at:

Note: Pressure is now open access (now listed under ‘Publications’ on the home page). This means you can invite your colleagues who may be considering membership in the UHMS to read it, too. We hope that getting a sampling of UHMS news will encourage them to join up.

Check it out today at


Update: 2016​ ASM | 9-11 June | Las Vegas, Nevada | USA

The Preliminary Program Schedule has been updated with the accepted abstracts and their presentation times (schedule is still subject to change). The Non-Physician Track will be posted within the next week.  Also, look for the full Abstract Program Book to be posted shortly.

Continuing Education Credits are currently in the approval process and will be posted soon.


Preliminary program: https://www.uhms.org/index.php?option=com_content&view=article&id=89&Itemid=236

Register now: https://www.uhms.org/index.php?option=com_civicrm&task=civicrm/event/register&Itemid=233&id=62&reset=1

Location & Accommodations
Las Vegas, Nevada: A desert metropolis built on gambling, vice and other forms of entertainment, Las Vegas has drawn millions of visitors and trillions of dollars in wealth to southern Nevada in just a century of existence. The city was founded by ranchers and railroad workers but quickly found that its greatest asset was not its springs but its casinos. Visitors came to partake in what the casinos offered: low-cost luxury and the thrill of fantasies fulfilled.

Tropicana Las Vegas Casino Hotel Resort: Prepare to be surprised. Located on the south end of the Las Vegas Strip, the Tropicana Las Vegas is redefining the expectations of today’s global travelers, with a recently completed $200 million transformation that provides a casually elegant resort experience. In addition to a South Beach rhythm and vibe, the transformation of the resort includes a fresh redesign of its best-in-class hotel rooms and suites, the 50,000-square-foot casino, more than 72,000 square feet of meeting and exhibition space, several new restaurants and bars, a new race and sports bar, and Glow®, a Mandara Spa and fitness center. First-class entertainment includes the Laugh Factory comedy club and live music in the Tropicana Lounge.

Please support the Society by booking at our host hotel!  Thank you! 

Tropicana Las Vegas Casino Hotel Resort
3801 Las Vegas Blvd. South
Las Vegas, NV 89109

Room rate:  Sun—Thurs: $85 / Fri-Sat: $145

Reservations: 1.800.GO2.TROP (1.800.462.8767) or 1.800.634.4000
In order for you to get the group rate you must give the reservations department our 
unique group code: SUHM16.


UHMS Call for abstracts deadline extended

THE CALL FOR ABSTRACTS for the Undersea and Hyperbaric Medical Society’s 2016 Annual Scientific Meeting has been extended to Friday, April 1, midnight Eastern Time.


Tropicana Las Vegas Casino Hotel Resort, Las Vegas, Nevada













Undersea & Hyperbaric Medical Society 
631 Highway 1, Suite 307
North Palm Beach, FL 33408
Phone: +919-490-5140/877-533-8467; Fax: +919-490-5149
Email: uhms@uhms.org; website: www.uhms.org


UHMS is gearing up for the 2016 ASM

I am excited to tell you about the upcoming 2016 Annual Scientific Meeting: It’s at the Tropicana Las Vegas Casino Hotel Resort in Las Vegas, Nevada on June 9-11, 2016.

While the conference is not until June, it is important to remember that abstracts are due on March 27, and award nominations are due by April 15.  Get more information on the UHMS website http://www.uhms.org.

We have some great precourses and postcourses this year. We will have our annual pre- and postcourses dealing with accreditation by Tom Workman. In addition, we have two fantastic precourses being held on Wednesday, June 8.

Our hyperbaric precourse will be “Hyperbaric Medicine Skills and Emergency Management” led by Dr. Enoch Huang and Dr. Sandra Wainwright. This will include lectures and demonstrations of hyperbaric-related emergency scenarios and procedures. It will include hands-on simulations of infrequently performed emergency procedures as well as peer-reviewed management of emergency hyperbaric scenarios.
The diving precourse will be “Harvesting and Aquaculture Divers Safety (HADS) Workshop” led by Dr. Neal Pollock and co-sponsored by DAN. This one-day workshop will promote understanding, education and safety within and concerning the worldwide harvesting and aquaculture diving community. Presentations will consider history, range of practice, operational guidance, accident patterns, clinical management, ongoing and emerging risks, and mitigation strategies.
We have some spectacular keynote speakers this year.  Dr. Richard Moon, the Lambertsen Lecture speaker, will be presenting “Investigations into Living and Working under the Water: Where Have We Been and Where Do We Need to Go?”  Dr. Michael Bennett, the Kindwall Lecture speaker, will be presenting “Medicine or Marketing? What We Need to Do to Survive in the 21st Century.”

We have multiple plenary sessions, with some great topics and speakers lined up.  We will have an extended plenary called “Access to Emergent Hyperbaric Therapy in the United States” which features two speakers: Dr. James Chimiak from DAN and Walter Chin, Past PacUHMS President from UCLA.

Dr. Folke Lind, our current Vice President, will lead a panel discussion on “International Perspectives on Hyperbaric Oxygen Therapy.”  Dr. Richard Baynosa, PacUHMS President and Chief of Plastic Surgery at UNLV, will present on “Flaps, Grafts, and Hyperbaric Oxygen Therapy.”  Dr. Simon Mitchell will be speaking on “Guidelines for Prehospital Management of Diving Injuries.”

Dr. Enoch Huang, our current President-Elect will present “Understanding Hyperbaric Dosing.”  Dr. Enrico Camporesi, our new UHM Journal editor, will speak on “The History and Evolution of UHMS Journals and Publications.”  We will have an optional noon plenary by Drs. Caroline Fife, Helen Gelly, and Marc Robins on “The Merit-Based Incentive Payment System, the National Hyperbaric Registry and the Future of US HBOT Reimbursement.”

The final plenary will but the very popular “New Pearls of Wisdom in the Diving and Hyperbaric Medicine Literature.” Two current UHM Fellows to present a summary of the most valuable articles in the field from the last several years. Brad Hickey (LSU) and Peter Ceponis (Duke/IMC) will be the presenters this year.

In addition, Valerie Short, Matt Schweyer and Kip Posey will be organizing the Associates (Non-Physician Track) Break-Out Session scheduled for June 9.  This should be a great program as well. They will be sending out information about that program soon.

I look forward to seeing you all in Las Vegas.  Start working on your abstracts, and register soon at https://www.uhms.org/annual-scientific-meeting/registration.html.

Dr. Jim Holm, President, UHMS


The UHMS Annual Scientific Meeting’s primary goal is to provide a forum for professional scientific growth and development of the participants to improve knowledge and competence in order to further patient outcome. The meeting provides a basis for exchange of ideas, both scientific and practical, among physicians, researchers, and other health professionals. The UHMS Annual Scientific Meeting consists of abstract and poster presentations, plenary sessions, the annual Kindwall and Lambertsen Lectures, and other social events. There will be exhibits from a number of hyperbaric, diving and wound care vendors. The Annual Meeting also affords an opportunity for participants to meet and interact with past and present leaders of the Society and to become active in Society affairs.

Important Changes in Medicare Code for Hyperbaric Oxygen Therapy: FAQs & Answers


Removal of C1300/emergence of G0277

Main Point: Payment methodology will be changing in hyperbaric medicine, and although the final interpretation and decision by CMS will not be published until March 2015, there are some points that can be shared with some certainty.

  • Will the reimbursement change for 99183 (“physician supervision of HBOT”)?

Answer: Yes

Code 99183 has never been valued by the American Medical Association Relative Value Update Committee (AMA RUC). It was given a value by CMS in 1994, and has remained unchanged since that time, with a work value of 2.34 RVUs (relative value units). This year, due to increased utilization (many more hyperbaric treatments being billed), 99183 was selected for review. The process of valuing a code includes a physician survey, a defining of the practice expense, and then a presentation in front of the RUC defending the request for keeping the value unchanged. The typical code that comes up for review is decreased about 20%. After much debate, the RVUs were determined to be 2.11. This represents approximately a 9% decrease in the payment for hyperbaric chamber supervision.

The reimbursement for physicians is comprised of three elements: work, indirect practice expense, and malpractice. When combined, the total RVUs for a facility based provider will be 3.13 RVUs. Those RVUs, multiplied by the conversion factor (CF) and your Geographic Price Index will give you the final amount. Nationally it should be in the range of $112.06. Currently the total RVUs for 99183 in a facility setting is 3.45 (CF $35.8228) for a national payment of $123.59.

  • How many units of 99183 does an advanced practitioner bill for supervising a hyperbaric treatment?

Answer: ONE

Physicians, or other qualified healthcare providers, will continue to bill for this professional service on a per session/treatment basis. FOR THE SUPERVSION OF HYPERBARIC OXYGEN THERAPY, PRACTITIONERS WILL CONTINUE TO BILL ONE (1) CODE 99183 FOR EACH HYPERBARIC OXYGEN THERAPY TREATMENT.

  • What will happen to C1300, the code previously used for billing the FACILITY (hospital) COMPONENT of hyperbaric oxygen therapy?

Answer: This code will be deleted.

C1300, Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval will be deleted.

  • What code will be used to bill the facility component of hyperbaric oxygen?

Answer: G0277

In place of C1300, a new code was created, G0277. It will have exactly the same description as C1300, but will not be limited to outpatient hospital sites of service (OPPS).

  • Why did CMS delete C1300?

Answer: As part of the AMA RUC process, the evaluation of 99183 resulted in a review of the DIRECT practice expense that is incurred by physicians providing hyperbaric oxygen therapy in a non-hospital based setting. The last time this was addressed was in 2004/2005 by CMS, and the inputs were not validated by the AMA RUC process. In that assessment, the value of oxygen for an ENTIRE monoplace hyperbaric oxygen treatment was $0.54. Air utilization was valued at $4.68 for air breaks. After rigorous debate at the AMA RUC meeting, revised direct practice expense inputs were recommended.

Interested stakeholders had been meeting with CMS to discuss the issue of physician supervision and the inequality of “practice expense” when compared to hospital based reimbursement. When CMS looked at the RUC recommendation, and took stakeholders comments concerning the discrepancy into consideration, they chose to create a code, G0277, which can be billed across all places of service.

  • What is the payment for the OPPS APC code 0659 / G0277

Answer: Currently, the OPPS APC code 0659 / G0277 will be paid at about $109.24 for a 30 minute segment. When billed at a place of service non-facility, the RVU value will be 1.32 x CF ($35.8013)/ 30 minutes.

  • When will we know the final decision of CMS?

Answer: CMS posted the first version of the Final rule with a comment period on physician reimbursement on October 31, 2014. The comment period ends December 30, 2014, and CMS will most likely release the final version with changes in March 2015.

  • Where can I find this information?

Answer: The Final Rule for OPPS is at:


The Final Rule for physicians is at:



The AMA has a large section that describes in detail all the relevant issues. The CF is based on a calculation that is influenced by the Sustainable Growth Rate. This is the “doctor fix” that keeps getting raised in Congress.



The UHMS CPG Oversight Committee, chaired by Dr. Enoch Huang, is at work on the first clinical practice guideline for the UHMS:  Clinical practice guideline for the use of hyperbaric oxygen therapy as adjunctive treatment of diabetic foot ulcers.

The UHMS recently posted the public comment draft of the document on the UHMS website http://www.uhms.org and this blog, along with a companion file with all of the Figures and Tables. The public comment period remained open until the end of the day on October 31, 2014. The original draft and accompanying tables are still accessible; the new draft will be announced when it is received.

At this point, the CPG Oversight Committee is addressing suggestions and refining the text.

“We’d like to thank those of you who took the time to submit public comments,” said Dr. Huang, who is serving as the lead reviewer on this CPG. “We are working hard to address all of the great points that were brought up.”

Some background: The goal of the project is to perform systematic meta-analyses of the hyperbaric literature for UHMS-approved indications and create clinical guidelines that will be readily available on the UHMS website.

In addition to having this information available on the Society website, the UHMS plans to post CPGs relating to hyperbaric oxygen therapy on http://www.guideline.gov, the National Guideline Clearinghouse, a public resource for evidence-based medicine under the aegis of the Agency for Healthcare Research and Quality and the U.S. Department of Health and Human Services.

“With the evidence-based support for hyperbaric oxygen available on http://www.guideline.gov, we believe that we can adequately refute insurance denials for reimbursement and provide guidance to our colleagues in other specialties on the appropriate request for hyperbaric medicine consultation,” noted Immediate Past President Dr. John Feldmeier in his Pressure column a year ago. Pressure is the bimonthly electronic newsletter for UHMS members.

The completion and publication of these guidelines is a complex and time-consuming effort. The UHMS has targeted these indications for initial work:

• diabetic foot ulcers;

• radiation soft tissue and bony necrosis;

• carbon monoxide poisoning; and

• compromised flaps and grafts.

CPGs for our other indications will follow. Watch for updates on this CPG in Pressure and UHMS social media.

With reports from:

Enoch Huang, M.D., Chair, CPG Oversight Committee, Lead Reviewer, Clinical Practice Guideline on Hyperbaric Oxygen Therapy for Diabetic Foot Ulcers

DFU CPG Public Comment TextDFU CPG rev Combined Figures and Tables