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Hyperbaric Physicians (and Hospital Program Managers): Check the 2023 Medicare Data! Protect Your NPI and Don’t Put Hospital Facility Fees at Risk

by | Jul 21, 2025 | Hyperbaric Oxygen Therapy | 0 comments

Hyperbaric Physicians (and Hospital Program Managers): Check the 2023 Medicare Data! Protect Your NPI and Don’t Put Hospital Facility Fees at Risk

A few days ago, the Department of Justice (DOJ) released information about individual indicted for health care fraud and one interesting case involved hyperbaric oxygen therapy. Yvoune Kara Petrie of Leesburg, Virginia was charged with health care fraud in connection with a medical clinic that provided hyperbaric oxygen therapy (HBOT). According to allegations, Petrie used the National Provider Identifiers (NPIs) of four physicians without their knowledge to submit fraudulent claims for hyperbaric chamber supervision to CareFirst, sometimes for hyperbaric treatments that were never even provided.

If you haven’t checked to see how your NPI is being used to charge for hyperbaric chamber supervision, you should! Medicare claims data lag 2 years behind so right now you can only check the 2023 Medicare claims data (or earlier) but it is public information. It takes less than 5 minutes to check out the charges for hyperbaric oxygen therapy which has only ONE physician service code: 99183. Even if you are not very good with spreadsheets, this one is easy to figure out: Medicare Physician & Other Practitioners – by Provider | CMS Data

Here’s a step-by-step guide:

Figure 1 shows you how to search by the hyperbaric code “99183”

Or you can search by your last name, as in Figure 2.

Once you find your name, scroll to the right and check that your address is correct as in Figure 3. If your NPI has been used to bill for services at any addresses other than the correct one, you know you have a problem!

 

You are not done quite yet. There’s one last thing you need to do which is to check to ensure that the correct site of service has been put on your claims. Here’s why. If you work at an on-campus hospital-based outpatient facility (HOPD) your claims should have been submitted as site of service 22 and the Medicare data on this website will indicate “F” for Facility. If you have an office-based hyperbaric practice, which is site of service 11, the Medicare files will indicate “O” for Office.

Figure 5 shows how you can filter by “Place of Service,” with the options being “O” (office) and “F” (hospital facility). If you filter by “O” and scroll to the left, you will probably see the names of colleagues who you know for certain work a hospital-based setting, but their physician claims are being incorrectly submitted as if it is a doctor’s office. THIS IS A BIG PROBLEM FOR THE DOCTOR, THE HOSPITAL AND FOR THE FIELD OF HYPERBARIC MEDICINE. Here’s why:

  1. The hospital could have to pay back all the associated facility fees for hyperbaric services: When physician clams are incorrectly submitted as if they are coming from their office, they are attesting to Medicare the hospital facility is really a doctor’s office. Medicare can claw back all the hospital facility fees associated with those treatments. Every hospital hyperbaric department manager should be checking to ensure that the doctors supervising hyperbaric treatments at their hospital are sending claims with the correct site of service.
  2. The practitioner has likely been overpaid by Medicare for wound care services and will have to pay the money back: Yes, it is true that the physician payment for hyperbaric chamber supervision is the same in the office-based setting as the hospital-based setting. Payments for hyperbaric chamber supervision are not the problem. The problem is that if the practitioner is also practicing wound care, all those physician payments are higher in the office-based setting. Medicare pays more for services provided in the office because the doctor is responsible for all the overhead costs (staff, equipment, etc.). Medicare pays less to doctor’s working in the HOPD because the hospital is being paid separately for all those ancillary costs. A doctor who is inadvertently submitting wound care claims as if the services were provided in a doctor’s office has been systematically overpaid by Medicare for non-hyperbaric charges. The doctor will have to pay that money back to Medicare with penalties.
  3. It can trigger a UPIC audit: There are Unified Program Integrity Contractors (UPIC) audits specifically targeting office-based hyperbaric (and wound care) services. HOSPITALS are typically the target of audits directed at facility-based programs (because “that’s where the money is” when it comes to recoupment). However, physician payments are being targeted under UPIC audits. If you work in a hospital-based facility but are incorrectly submitting claims indicating that yours is an office-based program, you could end up in an audit of your physician payments – and it will likely go downhill from there once the error is discovered.
  4. Incorrect data on office-based hyperbaric charges is causing Medicare to reevaluate hyperbaric physician and facility payment rates: While it is true that office-based hyperbaric services are increasing, office-based programs are not growing as fast as Medicare believes because many hyperbaric supervision charges are being submitted for the wrong site of service. CMS carefully monitors increases in charges for specific treatments and due to incorrect site of service data being submitted for HBOT, CMS thinks that there is a dramatic increase in office-based hyperbaric oxygen therapy. As a result of incorrect data, hyperbaric charges (both facility and physician payments) are on the CMS radar. News flash: CMS NEVER increases payments when it re-evaluates payment rates. Incorrect site of service claims are causing increased scrutiny of hyperbaric charges by Medicare and there is only one thing that can happen as a result – payment rates will decrease for everyone. Submitting the incorrect site of service on your hyperbaric physician claims can threaten the entire field of hyperbaric medicine with payment reductions.

It will take less time to check your 2023 Medicare data on hyperbaric chamber supervision than you just spent reading this post.

Additional Resources

The opinions, comments, and content expressed or implied in my statements are solely my own and do not necessarily reflect the position or views of Intellicure or any of the boards on which I serve.

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