TL;DR: Navigating HBOT insurance billing in Canada is one of the biggest operational challenges for clinic owners. Provincial billing codes, private insurance pre-authorisation, and the patchwork of coverage across provinces all require careful attention. This guide covers the billing codes that matter, how to maximise reimbursement, and how to help your patients access coverage they may not know they have.
Estimated reading time: 7 minutes
Hyperbaric oxygen therapy (HBOT) insurance billing in Canada is a complex landscape of provincial health plans, private insurance policies, and workers’ compensation pathways. Hyperbaric oxygen therapy billing in Canada is not a single system. It is a patchwork of provincial health plans, private insurance policies, auto insurance pathways, and workers’ compensation boards, each with different rules, codes, and approval processes. For clinic owners and operators, understanding this landscape is essential to both financial sustainability and patient access.
According to a 2024 analysis published in Undersea and Hyperbaric Medicine, the actual cost of HBOT to the healthcare system is lower than commonly cited in the literature, and per-patient costs have been decreasing over the past decade (Gelly et al., 2024). That is good news for clinics advocating for coverage expansion, but it requires clinic owners to be fluent in the billing codes and processes that make reimbursement possible.
At Canada Hyperbarics, we support clinic owners with the information they need to operate effectively within this complex environment.
What Are the Provincial HBOT Billing Codes in Canada?
Each province with public HBOT coverage uses its own billing code structure. Understanding your province’s codes is the foundation of successful billing.
Ontario (OHIP)
Ontario has the most comprehensive HBOT billing framework in Canada. OHIP covers all 14 UHMS-approved indications at both hospital-based programs and approved independent health facilities.
| Code | Description | Notes |
|---|---|---|
| G800 | Initial HBOT assessment | Billed once per patient per treatment course |
| G805 | HBOT treatment session | Per session – the primary billing code |
| A008 | Consultation | Specialist consultation fee |
Both hospital and OHIP-approved independent facilities bill these codes directly. Patients with a valid OHIP card and physician referral pay nothing out of pocket for covered indications. The Ontario Health Technology Assessment (2017) evaluated HBOT cost-effectiveness for diabetic foot ulcers and estimated a budget impact of $4 million per year in immediate treatment costs, decreasing to $0.5 million when downstream savings from avoided amputations were considered (Ontario HTA, 2017).
Alberta (Alberta Health)
Alberta covers approved HBOT indications at both AHS hospital clinics and CPSA-accredited private facilities.
| Code | Description | Notes |
|---|---|---|
| 13.99I | HBOT detention time (per 15 min) | Primary billing code for physician supervision |
The College of Physicians and Surgeons of Alberta (CPSA) accredits private hyperbaric clinics through on-site assessments and standard-setting. Accredited private facilities can bill Alberta Health directly for approved indications, giving clinic owners a clear reimbursement pathway.
Other Provinces
Quebec (RAMQ), British Columbia (MSP), Nova Scotia (MSI), and Newfoundland (MCP) cover HBOT at hospital-based facilities only. Private clinic operators in these provinces cannot bill the provincial plan directly. Patients must either pay out of pocket, use private insurance, or seek interprovincial referral. For a complete province-by-province breakdown, visit the Canada Hyperbarics coverage guide.
How Can Clinics Help Patients Access Private Insurance Coverage?
Private insurance is a significant revenue stream for HBOT clinics operating outside of provincial coverage. Many patients have extended health benefits that cover HBOT but do not know it. Clinic owners who proactively help patients navigate their benefits can improve both patient access and clinic revenue.
Key Steps for Clinics
- Ask about insurance at intake. Every new patient should be asked about their extended health benefits, auto insurance status, workers’ compensation eligibility, and Veterans Affairs coverage. Many patients do not think to check.
- Prepare pre-authorisation packages. Most private insurers require pre-authorisation for HBOT. Build a standard package that includes: physician referral letter, diagnosis and ICD code, proposed treatment plan with number of sessions, supporting clinical evidence, and facility accreditation documentation.
- Know the major insurers. Sun Life, Manulife, Canada Life (Great-West), Blue Cross, Desjardins, GreenShield, Industrial Alliance, and Equitable Life all have plans that may cover HBOT. Coverage typically falls under “paramedical services” or “medical equipment/treatment” categories.
- Document everything. Detailed treatment records with measurable outcomes (wound measurements, symptom scores, imaging) strengthen both initial claims and appeals.
- Help with appeals. If a claim is denied, help the patient request the denial in writing, prepare a letter of medical necessity, and submit supporting research. Most insurers have a formal appeals process.
What About Auto Insurance and Workers’ Compensation?
Auto Insurance (MVA)
For patients whose conditions resulted from a motor vehicle accident, HBOT may be covered through auto insurance benefits. In Ontario, this is submitted through the OCF-18 Treatment Plan via the HCAI (Health Claims for Auto Insurance) system. Acceptance of OCF-18 treatment plans involving HBOT is increasing as the therapy gains wider recognition. Your clinic can help prepare and submit the treatment plan to the patient’s auto insurer.
Workers’ Compensation (WSIB/WCB)
Work-related injuries requiring HBOT – including crush injuries, CO exposure at work, decompression sickness for commercial divers, and wound healing – may be covered through provincial workers’ compensation boards. Coverage is assessed case by case. The treating physician must submit a treatment plan demonstrating medical necessity. Contact WSIB (Ontario), WorkSafeBC, WCB Alberta, or your province’s equivalent.
What Does HBOT Actually Cost to Deliver?
Understanding your true cost per treatment is essential for sustainable pricing. Based on data from the Hyperbaric Oxygen Therapy Registry (HBOTR), which analysed 53 centres from 2013 to 2022, the estimated costs in USD are (Gelly et al., Undersea Hyperb Med, 2024):
| Component | Cost per 40 Sessions (2022 USD) |
|---|---|
| Facility cost | $19,488 |
| Physician cost | $4,346 |
| Total per patient | $23,834 |
| Single session | $596 |
These figures are from the US Medicare system, but they provide a useful benchmark for Canadian clinics. Notably, total costs decreased 15.6% from 2013 to 2022, largely driven by reduced physician costs. This data can be useful when advocating for coverage expansion with provincial health authorities.
How Can Clinics Advocate for Coverage Expansion?
For clinic owners in provinces where private HBOT is not publicly covered, advocacy is a long-term strategy. Consider these approaches:
- Collect and publish outcomes data. Provincial health authorities respond to local evidence. Track your patient outcomes rigorously and share aggregated data with decision-makers.
- Engage with professional bodies. The Canadian Undersea and Hyperbaric Medical Association (CUHMA) advocates for HBOT access nationally. Membership and participation strengthen the collective voice.
- Reference the Ontario model. Ontario’s coverage of 14 indications at both hospital and approved private facilities demonstrates that public coverage of private clinic HBOT is possible and cost-effective in Canada.
- Pursue accreditation. CPSA accreditation (Alberta) or equivalent provincial accreditation signals quality and safety, making the case for public coverage stronger.
What Should Clinic Owners Know About the Tax Implications?
Patients paying out of pocket for HBOT should be informed that treatment prescribed by a licensed physician may qualify under the Medical Expense Tax Credit (METC) on their Canadian tax return. Patients can claim on Line 33099 (for themselves) or Line 33199 (for a dependant). This does not directly affect clinic revenue, but it reduces the effective cost for patients and can be a factor in their decision to proceed with treatment. Always advise patients to consult a tax professional.
Frequently Asked Questions
Can private HBOT clinics bill OHIP in Ontario?
Yes. OHIP-approved independent health facilities can bill OHIP directly for all 14 UHMS-approved indications. The key requirement is OHIP approval of the facility and a valid physician referral for a covered condition.
How do I get my Alberta clinic CPSA-accredited?
Contact the College of Physicians and Surgeons of Alberta (CPSA) directly to begin the accreditation process. CPSA conducts on-site assessments and sets standards for hyperbaric facilities. Once accredited, your clinic can bill Alberta Health for approved indications.
What is the most commonly billed HBOT indication?
Based on registry data, non-diving diagnoses including diabetic ulcers and wound therapy account for approximately 59% of all HBOT treatments, making wound care the most commonly billed indication category.
How long does private insurance pre-authorisation take?
Typically 5 to 15 business days, depending on the insurer and the completeness of the documentation submitted. Having a standardised pre-authorisation package ready can significantly reduce delays.
Can I bill for HBOT consultations separately from treatments?
In Ontario, yes. The A008 consultation code and G800 initial assessment code are billed separately from the G805 per-session treatment code. Check your province’s billing schedule for equivalent codes.
Find Facilities Across Canada
For clinic owners looking to understand the competitive landscape or connect with other facilities, the Canada Hyperbarics facilities directory lists hospitals and regulated facilities across 10 provinces. Patients can also use the postal code search to find the nearest facility to them.
References
- Gelly HB, Fife CE, Walker D, Eckert KA. Trends in Medicare Costs of Hyperbaric Oxygen Therapy, 2013 through 2022. Undersea Hyperb Med. 2024;51(2):137-144. PubMed
- Health Quality Ontario. Hyperbaric Oxygen Therapy for the Treatment of Diabetic Foot Ulcers: A Health Technology Assessment. Ont Health Technol Assess Ser. 2017;17(5):1-142. PubMed
- Brenna CT, Salvatori M, Khan S, et al. The role of routine cardiac investigations before hyperbaric oxygen treatment. Diving Hyperb Med. 2024;54(2):120-126. DOI
This content is for informational purposes only and does not constitute medical or financial advice. Billing codes and coverage policies change frequently. Always verify current codes and coverage with your provincial health authority or insurer. Canada Hyperbarics is an independent educational resource and is not affiliated with any specific clinic or manufacturer.