Update: In a turn of events that the industry was hoping for, CMS reversed the 41% decrease in reimbursement for Hyperbaric Oxygen Therapy on December 21st, 2023. The 2024 rate for code G027 will now be set at $132.21, and not $73.64. This adjustment in reimbursement aligns with the earlier anticipated rate. 

“Medicare reimbursement is uncertain.” Rylan Smith, COO of Wound Care Advantage explains, “It is important to have a partner that is focused on the hospitals best interests, ensuring that they are well educated with actionable plans to address the revenue uncertainty instead of a management company protecting their share of the revenue you generate.” Wound Care Advantage made certain that each member of our network who provides HBOT understood what was happening first, before any public announcement. It was important to us, that no matter the outcome, they felt secure, and were given a voice to comment to CMS. 

We want to thank each member of our network for their commitment to treating patients and commenting to CMS. Along with our network, we would like to thank the Alliance of Wound Care Stakeholders, UHMS, and other key stakeholders for their quick response to CMS and their efforts to keep the industry updated.

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On November 3rd, 2023, it was announced by Centers of Medicare & Medicaid Services (CMS) that the reimbursement rate for Hyperbaric Oxygen Therapy will decrease by 41% on January 1, 2024 for the CPT code G027. The reimbursement rate which was anticipated to be around $134/30 minutes, has been unexpectedly set at $73.64 as the national unadjusted reimbursement rate, along with no change to the Physician fee schedule. Although the general consensus is that this was a mistake on CMS’ part, since there was no indication of a substantive change in the Proposed Rule that was released in July, it is still cause for concern. 

“Wound Care Advantage continues to stay on top of industry changes. So when CMS recently put out a notification of the potential changes to reimbursement for HBO starting next year, WCA quickly worked with industry players to provide feedback to CMS, and notify each clinic in our network.” explains Michael Curran, VP Center Operations - BS, CHT, DMT. Through one on one conversations with each Program Director, we’ve broken down what the potential change can mean, and how they can voice their concerns through a public comment to CMS. 

We at WCA will continue to combat this unforeseen and drastic 41% decrease in reimbursement by continuing to educate and prepare our network as if this change is not a mistake. We encourage those who wish to make a public comment to do so by following the below steps provided by the Undersea and Hyperbaric Medical Society UHMS:

In commenting, please refer to file code CMS-1786-FC. Comments must be submitted in one of the following three ways during the current open commenting period. 

1. Electronically. You may submit electronic comments on this regulation to https://www.regulations.gov. Follow the "Submit a comment" instructions.
2. By regular mail. You may mail written comments to the following address ONLY:
   Centers for Medicare & Medicaid Services, Department of Health and Human Services
   Attention: CMS-1786-FC, P.O. Box 8010, Baltimore, MD 21244-8010.
   Please allow sufficient time for mailed comments to be received before the close of the comment period.
3. By express or overnight mail. You may send written comments to the following address ONLY:
   Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1786-FC, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850.  

FOR FURTHER INFORMATION CONTACT: Au’Sha Washington, AushaWashington@cms.hhs.gov or 410-786-3736.

If you would like more information or to discuss what these reimbursement changes can mean, please contact us at  https://www.thewca.com/contact or by emailing info@thewca.com