Is EBO2 (EBOO) Covered by Insurance? What Medicare, the IRS, and Clinics Say About Paying

EBO2 (also called EBOO) is sold as an out-of-pocket service, and we found no evidence that health insurance or Medicare pays for it. The harder question is whether pre-tax money in a health savings account (HSA) or a health flexible spending arrangement (FSA) can, and there the answer turns on federal tax rules that put most of the risk on the person paying. This guide sets out what the primary sources say for each way of paying, what clinics say on their own pages, and the questions to ask a health plan and an account administrator before money changes hands. For what a course costs, see the cost guide.

The short answer: ozone therapy is not FDA-approved for any condition, and federal device rules describe ozone as a toxic gas with no known useful medical application [4]. As of October 4, 2026, none of the 174 clinic EBO2 pages we could read said insurance covers EBO2 [18]. An HSA or FSA can pay only for “medical care” as the IRS defines it, and the IRS publications that define it do not mention ozone therapy [1][2].

Does health insurance pay for EBO2?

Nothing we could verify says it does. As of October 4, 2026, 23 of the 174 clinics whose EBO2 pages we could read say that EBO2 is not covered by insurance or that the clinic does not accept or bill insurance, and none says insurance covers it [18]. One clinic answers “Do you take insurance?” with “Coverage varies by plan and service,” without saying whether EBO2 is ever covered [15]. A typical statement: “These are elective wellness services and are typically not covered by insurance in the United States. We do not bill insurance directly” [9]. Another clinic writes that it “does not accept medical insurance for EBOO treatments” [16].

Some clinics offer a way to try anyway. Five of the 174 say they give patients a superbill or an itemized receipt to submit for reimbursement, four of them to an insurer and one for HSA or FSA claims [12][13][18], and at least one says it does not provide superbills for EBOO at all [11]. One practice describes the arrangement this way: “I provide a superbill receipt for you to mail to your insurance company for any potential reimbursement,” adding that the patient is “responsible for handling any follow up process” [10]. A superbill shifts the claim to the patient; it does not change what the plan covers.

Private insurers publish their own medical policies. We do not read insurers’ websites directly for this guide, so their current wording on ozone therapy is listed under “What we could not verify” below.

Does Medicare or Medicaid pay for it?

Medicare’s rules exclude “any services that are not reasonable and necessary” for “the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member” [3]. Medicare decides what meets that test through national and local coverage determinations, published in the Medicare Coverage Database [6]. Our plain-text read of that database’s search for “ozone” listed no results, but its results load in a browser, so we could not confirm that no document addresses ozone therapy [6]. One clinic’s page states that it does not accept insurance, “including Medicare and Medicaid” [14].

Medicaid is run by each state. “States establish and administer their own Medicaid programs and determine the type, amount, duration, and scope of services within broad federal guidelines,” in the words of the federal Medicaid agency [5]. This guide does not survey state Medicaid policies.

Can an HSA pay for EBO2?

The test is whether the expense is medical care. IRS Publication 969 says an HSA’s “qualified medical expenses” are amounts paid for medical care as defined in the tax code, “but only to the extent the amounts are not compensated for by insurance or otherwise” [2]. Publication 502 defines medical expenses as the costs of diagnosing, treating, mitigating, or preventing disease, or of affecting a part or function of the body, and adds: “Medical care expenses must be primarily to alleviate or prevent a physical or mental disability or illness. They don’t include expenses that are merely beneficial to general health, such as vitamins or a vacation” [1]. Neither publication mentions ozone therapy or EBO2 [1][2]. Whether a given EBO2 session qualifies therefore depends on why the person is having it.

The account holder carries the risk. Paying with an HSA debit card counts as a distribution: Publication 969 says total distributions “include amounts paid with a debit card,” and the trustee reports them to the IRS [2]. The account holder “must keep records sufficient to show that” each distribution was “exclusively to pay or reimburse qualified medical expenses” [2]. If it was not, “the amount you withdraw will be subject to income tax and may be subject to an additional 20% tax” [2]. Nothing in Publication 969 says the HSA trustee approves an expense before it is paid [2], so a card accepted at the clinic’s front desk is not a ruling that the expense qualifies.

Can an FSA pay for EBO2?

An FSA has a gatekeeper. Publication 969 says an FSA’s qualified medical expenses “are those specified in the plan that would generally qualify for the medical and dental expenses deduction” [2], so the plan’s own rules decide. Before reimbursing, the plan needs “a written statement from an independent third party stating that the medical expense has been incurred and the amount of the expense,” plus a statement that no other plan has paid it [2].

Two FSA rules matter for EBO2 in particular [2]:

• No advance payment. “The FSA can’t make advance reimbursements of future or projected expenses.” A prepaid package of sessions not yet received is a future expense.
• Use it or lose it. FSAs “are generally ‘use-it-or-lose-it’ plans,” although a plan may allow a grace period of up to 2 1/2 months or a carryover, which for 2025 was capped at $660.

Does a doctor’s letter change the answer?

It can document the purpose, but it is not a pass. Publication 502 says lessons such as swimming “even if they are recommended by a doctor” do not count “if they are only for the improvement of general health” [1]. Neither IRS publication uses the phrase “letter of medical necessity” [1][2]. A clinician’s letter that names a diagnosed condition and explains why the treatment is for it speaks to the IRS test, primarily to alleviate or prevent an illness. An FSA plan still decides whether to reimburse, and for an HSA the account holder still answers to the IRS if it disagrees.

What do clinics say about paying?

As of October 4, 2026, 35 of the 174 clinics whose EBO2 pages we could read say something about insurance, tax-advantaged accounts, or financing [18]:

Five of the 14 that mention HSA or FSA payment hedge it, as in “Some clients use HSA or FSA funds where their plan allows” [9]. The rest state it plainly, such as “Insurance is not accepted, but HSA/FSA superbills are provided” [13] or “we do take HSA/FSA, cash and credit cards” [14]. The counts are per listing: the 35 come from 30 websites, because some clinics list several locations with the same pages. Acceptance at the front desk tells a reader how a clinic takes payment, not whether the IRS or a plan will treat the expense as qualified.

What should a reader check before financing?

Financing spreads the cost; it does not lower it. The Consumer Financial Protection Bureau reported in 2023 that medical credit cards and loans “often have deferred interest plans, with all accrued interest potentially becoming due at the end of a defined period, which can prove especially expensive and unaffordable for patients” [8]. Its report also notes that these products are marketed to healthcare providers, who are encouraged to promote them to patients [7]. One clinic advertises “0% interest for 12 months to 24 months on eligible plans” [17]; the terms after that period, and whether interest is deferred rather than waived, are the questions to ask. Financing a package also raises the question of what happens to the loan if sessions are not used, which our cost guide covers.

Step by step: questions to ask before paying

The health plan

1. Does the plan cover EBO2, or “extracorporeal blood oxygenation and ozonation,” under any circumstances? Ask for the plan’s medical policy on ozone therapy in writing.
2. If not, does the plan have out-of-network benefits, and would it consider a claim from a superbill?
3. Which billing codes would the clinic put on the superbill, and does the plan cover those codes? (Ask the clinic for the codes first.)
4. Is prior authorization required, and if a claim is denied, what is the appeal process and the deadline?
5. Are a consultation or lab tests billed separately, and are those treated differently from the procedure?

The HSA

1. Is this expense medical care for me under Publication 502, that is, primarily to alleviate or prevent a specific illness? A tax professional, not the clinic, is the right person to ask.
2. What records will I keep: the itemized receipt, the diagnosis, and any clinician’s statement of purpose?
3. Has any part of the expense been paid or reimbursed by insurance? That part cannot also come from the HSA.
4. Was the HSA open before the session took place? Expenses incurred before an HSA is established are not qualified medical expenses [2].

The FSA

1. Does the plan’s list of qualified expenses include EBO2 or ozone therapy? Ask for the answer in writing before buying.
2. What does the plan need to substantiate the claim: the independent third-party statement, a letter from a clinician, or both?
3. What are the plan year’s deadlines, and does the plan have a grace period or a carryover?
4. Will the plan reimburse a package only as each session is received?

The session cost planner totals a course, and the price check places a quote against published prices. For the regulatory background, see whether EBO2 is FDA approved; the clinic directory lists what each clinic states.

What we could not verify

• Private insurers’ current policies. An earlier version of this guide cited an Aetna clinical policy bulletin and an Oregon coordinated-care organization’s ozone policy. Both sit on private websites we do not read directly, so we could not re-check them for this update.
• Whether any Medicare coverage document addresses ozone therapy. The Medicare Coverage Database’s search results load in a browser, and our plain-text read listed none [6].
• State Medicaid policies. We did not survey them, so we cannot say whether any state names ozone therapy.
• Billing codes. We could not check which procedure codes, if any, clinics put on superbills, or whether any plan has paid on one.
• Plan decisions. We found no public record of an HSA trustee, an FSA plan, or the IRS ruling on an EBO2 expense.
• Prepaid packages and HSAs. The publications do not say when a prepaid package counts as incurred for HSA purposes.

How this guide was made

This guide rests on 18 sources: two IRS publications for tax year 2025, two federal regulations, four other federal pages (Medicaid.gov, the Medicare Coverage Database, and the Consumer Financial Protection Bureau’s 2023 report and its announcement), nine clinic pages cited only for what each clinic says about payment, and our own clinic dataset, which anyone can download. The clinic counts marked “As of October 4, 2026” come from reading the saved EBO2 pages of the 174 clinics we could read with confidence, out of 177 directory listings, all read between September 28, 2026 and October 4, 2026. Each payment statement was classified by reading it in context, and patient reviews quoted on clinic pages were not counted. We did not read private insurers’ or clinics’ sites for this update; all clinic text comes from pages saved on those dates. Drafting used AI tools. A human editor has not yet checked this guide claim by claim against its sources, and no clinical reviewer has signed off yet. This guide is not tax, legal, or medical advice.