Is EBO2 (EBOO) Covered by Insurance? HSA, FSA, and What You'll Pay

EBO2 (also called EBOO) is not covered by health insurance in the United States, and clinics that offer it price it as an elective, out-of-pocket service. That single fact drives most of what follows: no CPT billing pathway built around expected reimbursement, no Medicare coverage determination written for it, and an HSA or FSA answer that depends on your plan administrator rather than on the clinic’s marketing page. People searching for coverage are often really asking one of two different questions: will my insurer send a check, or can I at least pay with pre-tax dollars from an HSA or FSA. The answer to the first question is no, consistently, across every payer whose policy we reviewed. The answer to the second is more conditional and depends on documentation, which is why it gets its own section below. See what EBO2 is and how it’s administered for background on the procedure itself. This guide lays out the short answer and the reasoning behind it, what Medicare and Medicaid payer policies actually say, how HSA and FSA rules apply, and what to watch for in clinic financing offers.

The short answer, and why

Insurance does not pay for EBO2. Three things drive that outcome together. First, ozone is not FDA-approved to treat any condition; 21 CFR 801.415 describes it as a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy [6]. Second, there is no dedicated CPT procedure code that maps cleanly to EBO2 the way there is for, say, a standard infusion, which makes routine claims processing and reimbursement difficult even before a medical-necessity question arises. Third, and most directly, insurers that have written a policy on the subject classify it as unproven. Aetna’s clinical policy bulletin on complementary and alternative medicine lists ozone therapy under interventions it considers “experimental, investigational, or unproven,” citing inadequate peer-reviewed evidence of effectiveness [2]. A coordinated-care organization’s medical policy, dated 2020, is more direct still, stating that “all claims for services that involve any type of treatment or therapy with ozone are considered not covered” and will be denied at processing, and citing the same FDA language on ozone’s toxicity and lack of an established medical use [3]. We could not confirm whether this specific policy has been revised since 2020, so we cite it as an example of how a payer has written the rule down, not as any insurer’s current, definitive wording. Clinic-facing cost guides aimed at prospective patients say the same thing from the other side of the transaction: one describes EBOO as “considered an elective wellness procedure” that is “not covered by health insurance plans” [5]. Some clinics do mention a narrow workaround: submitting an itemized receipt, sometimes called a superbill, to your insurer yourself and asking for out-of-network reimbursement. One clinic notes that “patients with aggressive PPO plans or ‘Out-of-Network’ benefits have successfully received partial reimbursement” this way [4], though this depends entirely on your specific plan’s out-of-network terms, is not something the clinic controls, and is the exception clinics mention rather than a general path to coverage.

Medicare and Medicaid

Medicare follows the same logic as private insurers, for the same underlying reason: EBO2 has no FDA-approved use, and Medicare’s general standard requires a service to be reasonable and necessary for a covered indication before it pays. During research for this guide we searched the Medicare Coverage Database directly and reviewed a sample Medicare contractor’s noncovered-services determination; neither surfaced a National Coverage Determination written specifically for ozone therapy or EBO2. The clearest documented link we found between Medicare specifically and ozone’s non-covered status is the coordinated-care organization’s 2020 policy cited above, which states its ozone exclusion is “based on current Medicare and Oregon Health Plan benefits” [3]; absent a dedicated national determination, a Medicare claim for EBO2 would otherwise be evaluated, and denied, under the general “not reasonable and necessary” standard, which in practice reaches the same result: no payment.

Medicaid coverage is set state by state. That same 2020 policy doubles as the clearest documented example we found of a state Medicaid program’s treatment of ozone therapy: it lists ozone treatment among services considered experimental and states that related claims, including the procurement, assessment, administration, or monitoring of ozone, will be denied at the time they are processed [3]. There is no indication that other state Medicaid programs treat EBO2 differently, since the same absence of FDA approval and CPT pathway applies nationally rather than varying by state policy choice, though we would expect the exact wording of any given state’s policy to vary and, like the example above, to potentially be out of date by the time you read it.

HSA and FSA: what the IRS allows, letters of medical necessity, and the risk of a disallowed expense

Health savings accounts and flexible spending arrangements draw their rules from the same core IRS definition of qualifying medical care: expenses for the diagnosis, treatment, mitigation, and prevention of disease, or for affecting any structure or function of the body, so long as the expense is primarily to alleviate or prevent a physical or mental illness rather than for general health [1]. That definition is broad enough to already cover several treatments outside mainstream medicine. The IRS publication that defines these rules specifically allows amounts paid to a chiropractor, an osteopath, and even a Christian Science practitioner as medical expenses, provided the care is for a genuine medical purpose [1]. EBO2 is not named one way or the other in that guidance, which is exactly why the decision falls to your plan administrator rather than to the clinic charging you.

In practice, that decision often turns on documentation. When a treatment could plausibly be for general wellness rather than a diagnosed condition, plan administrators typically want a letter of medical necessity: a doctor’s written statement that a specific treatment is necessary for a specific diagnosis, not a general recommendation to feel better. One clinic’s own guidance to patients makes this connection directly, telling patients that a treatment recommended by a doctor “for a specific condition (e.g., inflammation, fatigue)” is more likely to “qualify as an IRS eligible medical expense” than one requested without a clinical reason attached [4]. A letter does not bind your plan administrator to approve the claim, and it does not change how an insurer classifies ozone therapy generally; it only gives the administrator a documented medical reason to consider.

The IRS publication that sets these rules also draws a line that matters here: amounts you contribute to an HSA are not themselves deductible medical expenses under this publication, and you cannot double up by deducting an expense you already paid for with tax-free HSA or FSA funds [1]. That is a separate point from whether an expense qualifies for the account in the first place, but it is a reminder that these accounts follow their own rulebook (Publication 969 governs HSA and FSA eligibility specifically) even though Publication 502’s definition of medical care is the reference point most plan administrators use when judging whether an expense counts. If a claim is later disallowed on audit, the withdrawn HSA funds can become taxable income plus a penalty, so it is worth confirming eligibility with your plan administrator in writing before you pay, rather than relying on a clinic’s assurance that “many patients use their HSA or FSA” for the treatment [4][5].

Financing offers and what to watch

Because EBO2 is paid out of pocket, clinics have an incentive to make the sticker price easier to absorb, and financing is a common way they do that. Clinic marketing describes both in-house payment plans and third-party medical financing arrangements, sometimes advertised with a promotional period of no interest [4]. The terms worth checking before signing anything are the interest rate that applies once a promotional period ends, whether the loan is structured to defer interest retroactively to the full original balance if it is not paid off in time, and whether packages of prepaid sessions are refundable if you stop partway through.

None of these terms are specific to ozone therapy, they are standard medical-financing questions, but they matter more here because the treatment itself is not a one-time low-cost item: package pricing and multi-session plans are the norm, not the exception, in how EBO2 is sold. A financing plan that spreads a multi-thousand-dollar package over a year can feel manageable month to month while still costing considerably more than the sticker price once interest is added, and unlike a mortgage or an auto loan there is no asset backing the loan if your circumstances change partway through a course of sessions. Ask specifically whether unused, financed sessions can be canceled and the remaining balance reduced accordingly, since not every financing arrangement allows that.

Total cost planning

Because none of the payment mechanisms above amount to assured insurance reimbursement, the realistic way to plan for EBO2 is to budget it as a fully out-of-pocket expense and treat any HSA, FSA, or financing option as a way to manage timing and cash flow, not as a discount. A single session runs about $799 to $2,000 in published 2026 pricing among the clinics we checked [7][8], and a course of several sessions is priced in the thousands; multiply whatever per-session figure a clinic quotes you by the number of sessions in its recommended course, add any package fee, and compare that total against what you would need to withdraw from an HSA or FSA in a single plan year, since annual contribution limits can matter if you are funding treatment from a account you are still contributing to. See our EBO2 cost guide for sourced per-session and package prices at several US clinics, and our guide to choosing a clinic for questions to ask about pricing transparency and refund terms before you commit to a package.

Bottom line

EBO2 is not covered by insurance, Medicare, or Medicaid, because it is not FDA-approved [6] and insurers that have addressed ozone therapy directly classify it as experimental [2][3]. HSA and FSA funds may be usable, but that is a decision made by your plan administrator based on IRS rules for qualifying medical care [1], not a guarantee extended by the clinic selling the treatment. A letter of medical necessity can help make that case; it cannot override how insurers already treat ozone therapy or force your plan to reimburse a disallowed claim. Confirm eligibility in writing before you pay, and read any clinic’s financing terms as carefully as you would any other medical loan.