Does G0277 require prior authorization?

No, G0277 does not require prior authorization (medium confidence). Covered without prior authorization by at least one policy, though another does not cover it.

What is the Medicare reimbursement rate for G0277?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`G0277`, Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization by at least one policy, though another does not cover it (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Imaging and laboratory/biomarker data used in studies: brain CT or MRI, amyloid PET (e.g., florbetapir), cerebrospinal fluid (CSF) biomarkers (Aβ1-42, total tau, phospho-tau), and APOE ε4 genotyping when reported in trials.
For some interventional procedures/trials, pre-procedure evaluations included medical/neurological and psychological examinations, depression rating scales (e.g., Montgomery–Asberg Depression Rating Scale), and lumbar puncture with CSF analysis.

Key Coverage Criteria

Hyperbaric Oxygen Therapy is medically necessary for the following conditions: acute traumatic peripheral ischemia/insufficiency, air or gas embolism, severe anemia when transfusion unavailable, avascular necrosis, carbon monoxide poisoning, central retinal artery occlusion, chronic osteomyelitis refractory to management, clostridial myonecrosis, compromised skin grafts/flaps, cyanide poisoning with CO poisoning, decompression sickness, delayed radiation injuries, diabetic lower extremity wounds [...]
None specified. This Clinical Policy Bulletin addresses experimental treatments for Alzheimer's disease and lists treatments considered experimental and investigational (i.e., not established as effective) for this indication.
No explicit covered indications are stated in this document. The document discusses potential therapeutic use in the following conditions:
Alzheimer's disease (AD)
mild cognitive impairment (MCI)
amnestic MCI

13 Active Policies

ANTHEM-CG-MED-73, Hyperbaric Oxygen Therapy (Systemic/Topical)

UHC-POL-hyperbaric-topical-oxygen-therapy, Hyperbaric Oxygen Therapy and Topical Oxygen Therapy

AETNA-CPB-0788, Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments

AETNA-CPB-0302, Xerostomia: Selected Treatments

AETNA-CPB-0389, Hypertrophic Scars and Keloids

AETNA-CPB-0327, Infertility

AETNA-CPB-0648, Autism Spectrum Disorders

AETNA-CPB-0406, Tinnitus Treatments

CIGNA-0053, Hyperbaric and Topical Oxygen Therapies

REGENCE-MED14, Hyperbaric Oxygen Therapy

UMR-POL-UMR-hyperbaric-topical-oxygen-therapy, Hyperbaric Oxygen Therapy and Topical Oxygen Therapy

SUREST-POL-SUREST-hyperbaric-topical-oxygen-therapy, Hyperbaric Oxygen Therapy and Topical Oxygen Therapy

CIGNA-0447, Autism Spectrum Disorders/Pervasive Developmental Disorders: Assessment and Treatment

`G0277`, Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

G0277, Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

`G0277`, Hyperbaric oxygen under pressure, full body chamber, per 30 minute interval