Department of Defense positions on alternative uses of hyperbaric oxygen therapy

Hyperbaric oxygen therapy is an existing and approved treatment to address multiple medical conditions, including decompression sickness, air or gas embolism, carbon monoxide poisoning, and profound blood loss when transfusion cannot be accomplished. However, recent efforts have emerged to promote hyperbaric oxygen therapy for other purposes. The most controversial applications have been utilizing this therapy as a treatment for mild traumatic brain injury and post-traumatic stress disorder. As evidence accumulates and the debate continues about whether published studies have satisfied the threshold of clinical significance, a common issue is raised regarding current clinical practices and health insurance coverage as allowed or recommended by the Department of Defense and other federal agencies. This review describes the current federal policies regarding medical insurance issues for providers and clinical practice guidelines as they pertain to alternative uses of hyperbaric oxygen therapy. First, the current policies are explored for what is reimbursable under federal insurance as approved clinical or research usages. Second, these policies are compared to the clinical practice guidelines to determine what might be clinical best practice versus exploratory research. Third, the evidence from government reports is reviewed as supporting documentation for these positions. As such, the current discussion addresses what can and cannot be covered under health insurance and where various federal health care organizations stand currently on using hyperbaric oxygen therapy as an alternative therapeutic technique. The primary goal is informing military healthcare practitioners and prospective patients about the treatment options available to them under current federal guidelines.