Conditions — Off-Label (Private Pay)

Off-Label Indications
(Private-Pay)

  • Private-pay — not covered by OHIP
  • Physician-led, evidence-anchored
Off-Label and Investigational Uses

Some of the conditions discussed on this site are not on Ontario’s OHIP-covered list and are not recognized indications by the Undersea & Hyperbaric Medical Society. We discuss these conditions because patients and physicians ask us about them, because there is a biologically defensible rationale for considering HBOT in selected cases, and because some patients elect to proceed on a private-pay basis with informed consent. The evidence base for off-label uses ranges from limited to mixed; we are explicit about this on each relevant page. The discussion of these conditions on this site is not an endorsement and is not a recommendation that they be treated with HBOT.

Outside OHIP Coverage

Selected Off-Label Indications

Outside the OHIP-covered list of indications, there are conditions for which hyperbaric oxygen therapy has a biologically plausible mechanism of benefit, is supported by an emerging evidence base, and is being explored in ongoing research. These are referred to as off-label indications.

Evolve Hyperbarics offers HBOT for selected off-label indications on a private-pay basis. All off-label treatment requires a consultation with one of our hyperbaric physicians, written informed consent acknowledging off-label use, and an honest discussion of the strength and limitations of the evidence.

Our Approach

Our Approach to Off-Label HBOT

We believe that off-label HBOT, used responsibly, can benefit certain patients. We also believe the field is harmed when clinics overstate the evidence or treat conditions without a defensible rationale. Our internal framework classifies off-label conditions by tier:

The off-label indications listed below fall in Tier 2A or 2B. We do not offer HBOT for indications without a defensible scientific basis, regardless of patient request.

Evolve’s evidence tiers for off-label indications

  • Tier 1 UHMS-approved indications — also OHIP-covered. Highest evidence and regulatory recognition.
  • Tier 2A Strong biological rationale plus randomized controlled trial evidence, but not OHIP-listed.
  • Tier 2B Strong biological rationale plus consistent observational evidence; randomized data emerging or limited.
  • Tier 3 Plausible mechanism, limited high-quality evidence. We generally do not treat at this level.
  • Tier 4 No defensible rationale. We decline.

What we do not offer

To be explicit: Evolve does not offer HBOT for general “wellness,” athletic performance enhancement in otherwise healthy individuals as a general wellness service, autism spectrum disorder, cerebral palsy as a primary indication, or any indication where we believe the evidence does not support a reasonable expectation of benefit. We will tell you honestly if your condition falls outside what we can responsibly offer.

Athletic recovery for competitive and high-performance athletes is distinct from general performance enhancement and is offered only in coordination with the athlete’s training staff and team physician — see the dedicated page under “Off-label conditions we offer” below.

What We Offer

Off-Label Conditions We Offer

Each of these falls within Tier 2A or 2B of our internal framework. Click a condition to view its evidence base, our approach, and the private-pay consultation pathway.

Tier 2A

Post-concussion syndrome & mild TBI

Post-concussion syndrome and persistent symptoms after mild traumatic brain injury.

View condition

Tier 2B

Long COVID

Long COVID with persistent cognitive or fatigue symptoms.

View condition

Tier 2B

Orthopedic delayed & non-union

Orthopedic delayed union and non-union, including calcaneal delayed union.

View condition

Tier 2B

Post-surgical recovery

Post-surgical recovery support in selected cases.

View condition

Tier 2A

Inflammatory bowel disease

Ulcerative colitis flares and IBD indications other than the OHIP-covered Crohn’s perianal fistulas.

View condition

Tier 2B

Infertility (adjunctive)

Adjunctive HBOT for selected cases, only in coordination with the patient’s reproductive endocrinologist.

View condition

Tier 2B

Athletic recovery

For high-performance athletes recovering from injury or competitive exertion, only in coordination with the athlete’s training staff and team physician.

View condition

Cost & Consent

Cost and Informed Consent

Off-label HBOT is not covered by OHIP. We will discuss current pricing at the consultation visit. Some patients have private insurance that may cover hyperbaric therapy under specific extended-health-benefit plans — you should verify with your insurer.

Every off-label patient signs an informed consent form that specifically acknowledges:
  • The proposed indication is not OHIP-covered
  • The proposed indication is not on the UHMS-approved list
  • The evidence base and its current limitations
  • Realistic expectations regarding response
  • The full risk profile of HBOT

References

  1. Moon RE (ed.). Hyperbaric Oxygen Therapy Indications. 14th ed. Best Publishing; 2019.
  2. Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine. Diving Hyperb Med. 2017;47(1):24-32.
  3. Heyboer M, Sharma D, Santiago W, McCulloch N. Hyperbaric oxygen therapy: side effects defined and quantified. Adv Wound Care. 2017;6(6):210-224.
Medical review

Dr. Vik Agarwal MD CCFP FRCPC CAQ-HP — President, Evolve Medical Group

Dr. Seema Agarwal MD CCFP CAQ-HP — Chief Medical Officer, Evolve Hyperbarics

Last reviewed: May 2026 · Next: May 2027

Get Started

Considering Off-Label HBOT?

Book a private-pay consultation with one of our hyperbaric physicians for an honest discussion
of the evidence, realistic expectations, and whether HBOT is appropriate for your situation. Call
1-888-851-4268 or request a consultation online.

Request a ConsultationSee OHIP-Covered Conditions