Intra-coronary Hyperoxemic Therapy (CPB 0801, reviewed 2026-10-28)
Aetna's Clinical Policy Bulletin 0801 states that intra-coronary hyperoxemic therapy, also called aqueous oxygen therapy, is experimental, investigational or unproven for carbon monoxide poisoning, cardiogenic shock, radio-contrast nephropathy, reperfusion microvascular ischemia in persons with acute myocardial infarction, and stroke, because the evidence is insufficient. The policy lists ICD-10 codes as not covered for the indications listed in the policy, and says there are no specific CPT or HCPCS codes for hyperoxemic therapy.