Texas requires podiatrists who administer hyperbaric oxygen to hold a TDLR permit: a UHMS-recognized team-training course, a $50 fee, two-year validity. Ohio has no permit but lets a podiatrist supervise therapy only with ACLS, a 40-hour hyperbaric course, ABFAS or ABPM board status and a consulting physician readily available (ORC 4731.511).
Hyperbaric oxygen therapy is a regular part of diabetic foot and wound care, and podiatrists often order it, supervise it or both. Most podiatry practice acts say nothing specific about it. Texas and Ohio do, and each adds a step a podiatrist moving there has to plan for.
What does Texas require?
The Texas Department of Licensing and Regulation (TDLR) states that "Every podiatric physician administering Hyperbaric Oxygen (HBO) must apply to the Texas Department of Licensing and Regulation for a permit," and that only licensed podiatric physicians may apply. The requirements on TDLR's permit page are short:
- Training: evidence of successful completion of "a hyperbaric medicine team training course that is recognized by the Undersea and Hyperbaric Medical Society."
- Fee: a nonrefundable $50. The fee rule lists the Hyperbaric Oxygen Certificate at $50 for initial and renewal certificates issued on or after January 1, 2025 (16 TAC 130.60).
- Term: certificates are valid for two years from the date of issue.
- Display: the certificate must be "clearly displayed in the office alongside the original license."
- Changes: holders must tell TDLR of any address change or "change of hospital setting" within 10 business days.
The permit sits on top of the Texas license, and the license itself comes first. For podiatrists licensed elsewhere that means the provisional license with a sponsor and the jurisprudence exam; see the Texas provisional license and the Texas jurisprudence exam. Keep in mind that Texas defines podiatry as treatment of "the human foot" (Occ. Code 202.001), so hyperbaric therapy ordered by a Texas podiatrist has to be for a condition within that scope.
Texas also issues a separate Nitrous Oxide permit, with its own training and a $50 fee, described in anesthesia limits by state.
What does Ohio require?
Ohio does not issue a permit. Instead, its statute sets conditions for a podiatrist to supervise the therapy. Ohio's scope section says hyperbaric oxygen therapy "may be ordered by a podiatrist to treat ailments within the scope of practice of podiatry" and that the podiatrist may supervise it under section 4731.511 (ORC 4731.51). Section 4731.511 defines the therapy as "the administration of pure oxygen in a pressurized room or chamber" and allows supervision only if all of these are true:
- The podiatrist has consulted with a physician whom the facility has authorized to perform hyperbaric oxygen therapy.
- The therapy is ordered only for treatment within podiatric scope.
- The podiatrist is certified in advanced cardiovascular life support by an organization the State Medical Board recognizes.
- The podiatrist has completed at least a 40-hour introductory course in hyperbaric medicine recognized by the American Board of Foot and Ankle Surgery or the Undersea and Hyperbaric Medical Society.
- The podiatrist is board-certified or board-qualified by ABFAS or the American Board of Podiatric Medicine.
During therapy, the podiatrist "must be immediately available," and the consulting physician must be "readily available for consultation" in case a complication arises outside podiatric scope. The physician does not need to be on site; timely communication in person or by oral, written or electronic means is enough. On request, the podiatrist must show the board proof of the ACLS certification and the hyperbaric course.
How do the two approaches compare?
- Texas licenses the activity: a separate TDLR certificate, renewed every two years, with a team-training course.
- Ohio regulates the supervisor: no extra state document, but board status, a 40-hour course, current ACLS and a consulting physician arrangement at the facility.
A podiatrist working for a wound-care company in both states needs both sets of paperwork, and they do not overlap neatly. A Texas team-training certificate is not automatically the 40-hour introductory course Ohio describes, and Ohio's board status requirement has no Texas equivalent. For the wider picture on wound-care staffing across states, see wound-care companies: scope checks before a podiatrist starts.
Which documents should a wound center keep on file?
- For Texas podiatrists: the current HBO certificate, its expiration date and the training certificate behind it.
- For Ohio podiatrists: the ACLS card and expiration, the 40-hour course certificate, the ABFAS or ABPM letter, and the name of the authorized consulting physician.
- For both: the facility's own medical staff privileges for hyperbaric supervision, which are separate from state law. Privileging is covered by our sister site, White Glove Credentialing.
Can we handle the Texas permit?
Yes. Our Procedure Permit service ($199 per permit, see pricing) prepares the TDLR hyperbaric or nitrous oxide application, checks your training certificate against the stated requirement, and puts the renewal date on your calendar. For Ohio, we assemble the supervision file as part of the Ankle & Scope Credential Add-On ($499). You complete the training and certifications yourself and pay TDLR directly. State details are on the Texas and Ohio pages.
Common questions
- How long is a Texas hyperbaric oxygen permit valid?
- Two years from the date of issue, according to TDLR. The fee is $50 for certificates issued or renewed on or after January 1, 2025 (16 TAC 130.60).
- Does the consulting physician have to be on site in Ohio?
- No. ORC 4731.511 requires the physician to be readily available for consultation, which can be in person or by oral, written or electronic communication. The podiatrist must be immediately available.
- Can a board-eligible podiatrist supervise hyperbaric therapy in Ohio?
- The statute requires board certification or board qualification by ABFAS or ABPM, plus ACLS and a 40-hour introductory hyperbaric course.
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