TLDR

Hyperbaric Oxygen Therapy (HBOT) is FDA-approved and covered by Medicare and most PPO insurance plans for diabetic foot ulcers classified as Wagner Grade 3 or above. Clinical evidence shows HBOT can increase healing rates by up to 4x compared to standard wound care alone — and significantly reduce the risk of amputation. At OxygenWell in Sherman Oaks and Calabasas, we deliver medical-grade HBOT at up to 2.4 ATA, the pressure level required to produce genuine tissue healing.

Table of Contents

• What Are Diabetic Foot Ulcers?
• Why Diabetic Wounds Don't Heal on Their Own
• How HBOT Heals Diabetic Foot Ulcers
• What the Clinical Evidence Shows
• Who Qualifies for Insurance-Covered HBOT?
• What to Expect at OxygenWell
• Frequently Asked Questions

What Are Diabetic Foot Ulcers?

A diabetic foot ulcer is an open wound or sore that occurs on the foot of a person with diabetes, most commonly on the bottom of the foot. According to the American Diabetes Association, approximately 15% of people with diabetes will develop a foot ulcer during their lifetime — and for many, that wound becomes a serious medical crisis.

Diabetic foot ulcers are classified using the Wagner Grading System:

• Grade 0: No open lesion; pre-ulcerative site
• Grade 1: Superficial ulcer, no subcutaneous tissue involvement
• Grade 2: Deep ulcer to tendon, capsule, or bone
• Grade 3: Deep ulcer with abscess, osteomyelitis, or joint infection
• Grade 4: Gangrene of the forefoot
• Grade 5: Gangrene of the entire foot

HBOT is FDA-approved and Medicare/PPO-covered for Wagner Grade 3 and above when standard wound care has not produced measurable improvement after 30 days.

Why Diabetic Wounds Don't Heal on Their Own

Diabetes causes two physiological problems that make wound healing extremely difficult: peripheral neuropathy (nerve damage that prevents the patient from feeling injury) and peripheral vascular disease (poor blood flow that starves tissues of the oxygen they need to repair).

Oxygen is the single most important raw material for wound healing. Without it, the body cannot:

• Produce collagen — the structural protein that closes wounds
• Kill bacteria — white blood cells require oxygen to function
• Form new blood vessels — angiogenesis depends on oxygen availability
• Regenerate tissue — cellular repair pathways stall without adequate oxygenation

Standard wound care addresses the wound surface. HBOT addresses the root cause: oxygen deprivation at the cellular level.

How HBOT Heals Diabetic Foot Ulcers

During an HBOT session, a patient breathes 100% medical-grade oxygen inside a pressurized chamber at 2.0–2.4 atmospheres absolute (ATA). This increased pressure forces oxygen to dissolve directly into the blood plasma — bypassing hemoglobin entirely — and delivers oxygen to tissues that compromised blood vessels can no longer reach.

For diabetic foot ulcers specifically, HBOT produces four critical biological effects:

1. Hyperoxygenation of Ischemic Tissue

Tissue oxygen levels around a diabetic wound often fall below 30 mmHg — far too low to support healing. A single HBOT session raises tissue oxygen levels to 200–400 mmHg in the treated area, creating the oxygen gradient the body needs to initiate repair. [Hopf HW et al., Wound Repair Regen. 2004]

2. Neovascularization — New Blood Vessel Formation

Repeated HBOT sessions trigger the release of Vascular Endothelial Growth Factor (VEGF), which stimulates the growth of new capillaries into oxygen-deprived tissue. This process — angiogenesis — rebuilds the local circulation that diabetes has destroyed. [Thom SR, J Appl Physiol. 2011]

3. Antimicrobial Action

Oxygen is directly toxic to anaerobic bacteria — the class most responsible for serious diabetic wound infections. HBOT also enhances the bactericidal activity of neutrophils, which require oxygen to kill pathogens effectively. [Knighton DR et al., Surgery. 1986]

4. Collagen Synthesis and Wound Closure

Collagen production — the primary mechanism of wound closure — requires oxygen as a direct cofactor. HBOT restores the oxygen availability that collagen-producing fibroblasts need to function, accelerating wound closure and reducing recurrence risk.

What the Clinical Evidence Shows

Healing Rates Up to 4x Higher

A landmark study published in Undersea and Hyperbaric Medicine found that patients with Wagner Grade 3+ diabetic foot ulcers who received HBOT had healing rates up to 4 times higher compared to standard wound care alone. [Marx RE & Johnson RP, Undersea Hyperb Med. 2019]

Significant Reduction in Major Amputation Risk

A randomized controlled trial by Löndahl et al. found that patients with non-healing diabetic foot ulcers who received HBOT were significantly more likely to achieve complete wound closure at one year, with a substantially lower risk of major amputation compared to placebo. [Löndahl M et al., Diabetes Care. 2010]

Cochrane Systematic Review

A Cochrane review of HBOT for chronic wounds confirmed that HBOT significantly reduces the risk of major amputation and increases wound healing rates at one year in patients with diabetic foot ulcers. [Kranke P et al., Cochrane Database Syst Rev. 2015]

Medicare and CMS Recognition

The Centers for Medicare & Medicaid Services (CMS) cover HBOT for diabetic foot ulcers — a designation that reflects the consistency and strength of the clinical evidence base. This is a recognized, reimbursable component of wound care for qualifying patients.

Who Qualifies for Insurance-Covered HBOT?

To qualify for Medicare or PPO insurance coverage, patients must meet the following criteria:

• Diagnosis of Type 1 or Type 2 diabetes
• Wound classified as Wagner Grade 3 or higher
• Standard wound care administered for at least 30 days without measurable improvement
• Physician referral (OxygenWell coordinates this directly with your referring physician)

OxygenWell performs insurance verification before your first session and handles all pre-authorization paperwork. Verify your insurance coverage here.

What to Expect at OxygenWell

OxygenWell is a physician-owned hyperbaric oxygen therapy center with locations in Sherman Oaks and Calabasas, CA. Founded and led by Dr. Beth Meneley, DAOM, L.Ac., with 25+ years in integrative medicine and 12+ years dedicated to hyperbaric medicine in Los Angeles, OxygenWell has delivered over 50,000 HBOT sessions.

Our Diabetic Foot Ulcer Protocol

• Pressure: 2.0–2.4 ATA
• Session length: 90 minutes
• Frequency: 5 days per week
• Total sessions: Typically 30–40, adjusted to patient response
• Oxygen: 100% medical-grade, high-flow delivery

Why Pressure Matters

Many HBOT centers operate at 1.3–1.5 ATA using standard oxygen concentrators. At these pressures, tissue oxygen levels do not reach the therapeutic threshold required for angiogenesis and serious wound healing. OxygenWell's Fortius 420 chambers operate at up to 2.4 ATA with 100% medical-grade oxygen at high flow — the clinical standard for wound healing.

Frequently Asked Questions

How many HBOT sessions does it take to heal a diabetic foot ulcer?

Most protocols for diabetic foot ulcers involve 30–40 HBOT sessions delivered 5 days per week. The exact number depends on wound severity, overall health, and healing response. Our clinical team monitors progress and adjusts the protocol accordingly.

Is HBOT covered by insurance for diabetic foot ulcers?

Yes. Medicare and most PPO plans cover HBOT for Wagner Grade 3+ diabetic foot ulcers that have not responded to 30 days of standard wound care. Call OxygenWell at (818) 661-0939 or visit oxygenwell.com to verify your coverage.

Can HBOT prevent amputation?

Clinical evidence supports HBOT as a significant reducer of major amputation risk in patients with severe diabetic foot ulcers. Multiple RCTs and systematic reviews show higher wound closure rates and lower amputation rates with HBOT versus standard care alone.

Is HBOT safe for patients with diabetes?

Yes. HBOT is safe for diabetic patients when administered in a physician-led facility. Blood glucose is monitored before each session, as HBOT can cause transient decreases in blood sugar. OxygenWell checks glucose levels at every visit.

Do I need a physician referral?

Yes — a physician referral is required for insurance-covered HBOT. OxygenWell works directly with referring physicians and wound care teams. If you do not have a referring physician, contact our team and we will facilitate the referral process.

Schedule a Consultation

If you or a patient has a diabetic foot ulcer that has not responded to standard wound care, HBOT may be the next clinical step — and it may be covered by insurance.

• Sherman Oaks: 15301 Ventura Blvd., Suite P12, Sherman Oaks, CA 91403
• Calabasas: 23500 Park Sorrento, A2, Calabasas, CA 91302
• Phone: (818) 661-0939
• Website: oxygenwell.com

Written by Dr. Beth Meneley, DAOM, L.Ac. — Founder of OxygenWell. 25+ years in integrative and functional medicine. 12+ years dedicated to hyperbaric medicine in Los Angeles. Over 50,000 HBOT sessions administered under her clinical direction.