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RevitalizeMe Hyperbaric Oxygen Therapy & Wound Care
3200 Cabaret Trail S. Ste. 3, Saginaw, MI 48603
(989) 320-4434
Fax: (989) 256-0507

April 18, 2026

Dear Referring Physician,

I am writing to request a referral to RevitalizeMe Hyperbaric Oxygen Therapy & Wound Care in Saginaw, Michigan for evaluation and treatment of Air or Gas Embolism.

RevitalizeMe is a Medicare- and insurance-credentialed outpatient center specializing in FDA-approved hyperbaric oxygen therapy (HBOT) and advanced wound care. Their services are covered by Medicare, Medicaid, and most major private insurance plans.

Per CMS NCD 20.29, Air or Gas Embolism is a covered indication for hyperbaric oxygen therapy when medically necessary. I understand that Medicare requires documentation of prior standard care before HBOT authorization.

I would appreciate your consideration of this referral. RevitalizeMe can be reached directly at (989) 320-4434 to coordinate my care.

Sincerely,

Patient Name:
Date of Birth:
Date: April 18, 2026