10-Pass Ozone Therapy: What It Is, How It Differs, and Is It Worth the Cost?

10-pass ozone therapy, also called hyperbaric ozone autohemotherapy, draws about 200 ml of blood, mixes it with ozone under positive pressure and returns it, ten times in one 60 to 90 minute session, for roughly ten times the ozone dose of a single standard major autohemotherapy (MAH) treatment. It typically costs $800 to $2,500 per session against $150 to $400 for standard MAH, and no randomized controlled trial has shown that the extra dose produces better outcomes, so whether it is worth the cost is still a judgment call made with incomplete data.

If you have been researching ozone therapy for any length of time, you have probably encountered the term “10-pass”, often presented as the most powerful form of ozone therapy available. It is the treatment that ozone therapy clinics promote for their most complex cases, the protocol that generates both enthusiasm and skepticism in roughly equal measure, and the procedure that carries the highest price tag in the ozone therapy world.

10-pass differs from standard major autohemotherapy (MAH) in five ways that matter to a patient: dose, equipment, session length, cost and the strength of the evidence. Each of those differences bears on whether the higher price is justified for a given condition. The ozone therapy treatment guide covers the wider family of ozone methods if 10-pass is your first introduction to the field.

What Is 10-Pass Ozone Therapy?

To understand 10-pass, you first need to understand standard major autohemotherapy (MAH). In standard MAH, a physician draws approximately 100 to 250 ml of your blood into a glass bottle or bag, mixes it with a precise concentration of ozone/oxygen gas, and returns the ozonated blood to your body through an IV. This is one “pass”, one cycle of draw, ozonate, return.

10-pass ozone therapy, also called high-dose ozone therapy (OHT) or hyperbaric ozone autohemotherapy, repeats this cycle ten times in a single session. Using a specialized device, 200 ml of blood is drawn, mixed with 200 ml of ozone at a concentration of 70 mcg/ml under positive pressure (hyperbaric conditions), and returned. This process is repeated ten times, exposing a total of approximately 2,000 ml of blood to ozone during the session.

The math is straightforward: ten passes delivers roughly ten times the total ozone dose of a single standard MAH treatment. Where a standard MAH might deliver 2,000 to 6,000 mcg of ozone total, a 10-pass session delivers approximately 140,000 mcg (140 mg) of ozone. That is a dramatic increase in dose intensity.

What other names does 10-pass ozone go by?

Clinics describe the same procedure as 10-pass ozone, ten pass ozone, multipass ozone, hyperbaric ozone autohemotherapy, and high-dose ozone therapy (OHT). Shorter versions are sold as 3-pass, 5-pass or 7-pass ozone. All of them belong to the family of ozonated autohemotherapy, which also includes single-pass MAH, EBOO (extracorporeal blood ozonation and oxygenation) and ozone combined with ultraviolet blood irradiation.

How does ozone act on the blood?

Ozone mixed with blood reacts almost at once with plasma antioxidants and fatty acids, producing short-lived messengers such as hydrogen peroxide and lipid oxidation products. According to Velio Bocci and colleagues in the Journal of Translational Medicine (2011), this mild, controlled oxidative stress follows a hormetic dose-response curve: a small dose prompts cells to switch on their own antioxidant and repair systems, while too large a dose can overwhelm them. That curve is the central question behind 10-pass, which raises the dose tenfold without published data on where the useful range ends.

The Herrmann/Zotzmann Protocol

The 10-pass technique was developed by Dr. Johann Lahodny, an Austrian physician, using the Zotzmann Ozonosan (later called the Herrmann device), a specialized ozone delivery system manufactured in Germany. The device is purpose-built for multi-pass autohemotherapy and includes features that standard MAH equipment lacks:

• Hyperbaric ozone mixing: The blood-ozone mixture is exposed under positive pressure, which increases ozone dissolution into the blood beyond what is achievable at atmospheric pressure.
• Automated cycling: The device manages the draw-ozonate-return cycle with consistent volumes and pressures, reducing variability and practitioner error.
• Heparin integration: A small amount of heparin (blood thinner) is used to prevent clotting during the extended procedure, which lasts 60 to 90 minutes.
• Closed system: The blood remains in a closed circuit, reducing contamination risk during the multiple cycles.

The original protocol specifies 200 ml blood per pass, 200 ml ozone/oxygen gas at 70 mcg/ml concentration, positive pressure of approximately 0.8 bar, and all ten passes completed in a single session. Some practitioners have modified this protocol, using fewer passes (5-pass or 7-pass), different concentrations, or different volumes, but the term “10-pass” specifically refers to the full ten-cycle protocol.

Who Uses 10-Pass and For What?

10-pass ozone therapy is most commonly used for complex, chronic conditions where standard ozone protocols have provided some benefit but have plateaued, or where the severity of the condition warrants a more intensive approach from the start. The most common clinical applications include:

Chronic Lyme disease and co-infections: This is probably the single most common reason patients seek 10-pass therapy. The theory is that the higher ozone dose provides greater antimicrobial activity against Borrelia burgdorferi and common co-infections (Babesia, Bartonella, Ehrlichia). Many Lyme-literate physicians who offer ozone therapy consider 10-pass their most potent ozone-based intervention for persistent Lyme symptoms. The Lyme disease condition page explains the standard antibiotic approach that ozone is usually layered on top of.

Chronic viral infections: Including Epstein-Barr virus (EBV) reactivation, chronic hepatitis, herpes simplex, and other persistent viral conditions. Ozone has demonstrated antiviral properties in laboratory studies, and the higher dose delivered by 10-pass is hypothesized to be more effective against entrenched viral reservoirs.

Autoimmune conditions: Some practitioners use 10-pass as an immunomodulatory treatment for autoimmune diseases, including rheumatoid arthritis, lupus, multiple sclerosis, and Hashimoto’s thyroiditis. The rationale is that ozone’s immunomodulatory effects, rather than immunosuppressive effects, may help rebalance a dysregulated immune system.

Mold illness and biotoxin exposure: Patients with chronic inflammatory response syndrome (CIRS) related to toxic mold exposure sometimes undergo 10-pass as part of an in-depth detoxification and immune support protocol.

Cancer support: Some integrative oncology clinics offer 10-pass as an adjunctive therapy alongside conventional cancer treatment. The intent is to support immune function and potentially enhance the oxidative stress on cancer cells, though evidence for this application is limited to case reports and small series.

Fatigue syndromes and long COVID: Some integrative clinics also offer 10-pass to patients with chronic fatigue syndrome, long COVID or other post-viral fatigue. Published support for these uses is thinner still, consisting mainly of practitioner experience rather than studies of 10-pass itself.

Which clinicians offer 10-pass ozone therapy?

In the United States, 10-pass is offered mainly by integrative and functional medicine physicians (MDs and DOs), Lyme-literate physicians, and naturopathic doctors (NDs) in states where IV therapy falls within their scope of practice. Nurses or physician assistants often place the IV and monitor the session under a supervising clinician. Because the procedure involves heparin and repeated large blood draws, the supervising clinician should be able to manage bleeding, vein problems and fainting on site.

Standard MAH vs. 10-Pass: A Direct Comparison

The table shows the trade in one view: 10-pass treats about eight to twenty times more blood than a single MAH, takes about twice as long, needs heparin and a dedicated device, and costs several times more, while resting on a thinner evidence base. Readers comparing the two methods in more depth can start with the overview of single-pass MAH ozone therapy.

How Much Does 10-Pass Ozone Therapy Cost?

A single 10-pass ozone session typically costs $800 to $2,500 in the United States, compared with $150 to $400 for a standard MAH session. The gap reflects the dedicated device (often quoted at $30,000 or more), the longer chair time of 60 to 90 minutes, heparin and disposable tubing, and the extra staff time needed to run ten cycles safely.

Most patients are not quoted a single session. Clinics usually propose a course, and the total climbs quickly: a series of 6 to 10 sessions, which is common in chronic Lyme and autoimmune protocols, can reach $5,000 to $25,000 out of pocket.

Prices vary by region, by device and by what the quote includes. Ask whether the price covers the consultation, baseline blood work such as a G6PD test, IV placement, any vitamin C or glutathione add-ons, and follow-up visits. The full breakdown of 10-pass ozone therapy cost compares pricing structures and package deals in more detail.

Does insurance cover 10-pass ozone therapy?

Health insurance rarely covers 10-pass ozone therapy, because the FDA does not recognize any medical use for ozone and insurers treat the procedure as investigational. Some patients ask their clinic for an itemized receipt to submit for possible reimbursement or to use with a health savings or flexible spending account, but eligibility depends on the plan administrator and is not assured.

Claims vs. Evidence: An Honest Assessment

Here is where intellectual honesty requires us to draw some clear lines.

What we can say with confidence: Ozone therapy, broadly, has a substantial evidence base supporting its biological effects, it stimulates antioxidant enzyme systems, modulates the immune response, improves oxygen delivery, and has documented antimicrobial properties. Standard MAH has been studied in randomized controlled trials for conditions including peripheral arterial disease, diabetic foot ulcers, chronic hepatitis, and low back pain.

What we cannot say with confidence: That 10-pass is specifically superior to standard MAH, or that the dramatically higher dose translates to proportionally better clinical outcomes. There are no published randomized controlled trials comparing 10-pass to standard MAH. The evidence for 10-pass specifically consists of clinical observations, practitioner reports, case series, and patient testimonials, not controlled studies.

This is an important distinction. The biological plausibility is there, higher ozone exposure likely does produce a more intense biological response. And the clinical reports from experienced practitioners are genuinely impressive in many cases. But “impressive clinical reports” is a lower standard of evidence than “demonstrated in controlled trials,” and the history of medicine is full of treatments that looked promising in clinical practice but did not hold up under rigorous testing.

Does this mean 10-pass does not work? No. It means we do not have the quality of evidence needed to make definitive claims about its superiority over standard MAH. For a treatment that costs five to ten times more per session, that uncertainty is relevant to the decision-making process.

What would show that 10-pass works better than MAH?

The missing piece is a randomized trial that assigns similar patients to 10-pass, to standard MAH and ideally to a sham or usual-care group, then measures symptoms, lab markers and side effects over months rather than days. Until such a study is published, claims that 10-pass outperforms MAH rest on clinical experience. Patients can search ClinicalTrials.gov for ozone autohemotherapy to see whether any registered study is recruiting, and the summary of reported 10-pass ozone therapy benefits separates what practitioners report from what has been measured.

Is 10-Pass Ozone Therapy FDA Approved?

10-pass ozone therapy is not FDA approved for any condition. Federal regulation 21 CFR 801.415 states that ozone “is a toxic gas with no known useful medical application in specific, adjunctive, or preventive therapy,” and the FDA has not cleared any ozone generator or multipass device for treating disease.

In practice, US physicians who offer 10-pass do so under their state medical license as an off-label, cash-pay procedure, and state medical and naturopathic boards set the limits on who may perform IV therapies. That legal position is why insurers decline coverage and why the burden of checking training, equipment and emergency readiness falls on the patient. The explainer on whether ozone therapy is FDA approved covers the regulatory history in more depth.

What a 10-Pass Session Looks Like

If you decide to pursue 10-pass ozone therapy, here is what to expect:

Before the session: You will need adequate IV access, typically a large-bore IV catheter or, for patients doing repeated 10-pass sessions, sometimes a peripherally inserted central catheter (PICC line). You should be well-hydrated. Some clinics recommend specific supplements before and after treatment (vitamin C, glutathione, and other antioxidant support), though protocols vary.

During the session: The practitioner places the IV, administers a small dose of heparin, and connects you to the 10-pass device. The machine draws approximately 200 ml of blood, mixes it with ozone under pressure, and returns it. This cycle repeats ten times over 60 to 90 minutes. Most patients describe the procedure as tolerable but not comfortable, the blood draw and return can cause mild sensations of pressure or temperature change. Some patients feel energized during the treatment; others feel fatigued.

After the session: Some patients feel immediately energized; others feel tired or experience a “Herxheimer-like” reaction (flu-like symptoms, fatigue, headache) in the hours or days following treatment, particularly if the treatment is targeting chronic infections. These reactions are generally interpreted as a sign of microbial die-off and toxin release. They typically resolve within 24 to 72 hours.

Treatment frequency: Protocols vary widely depending on the condition and practitioner. Common schedules include weekly sessions for 6 to 10 weeks (intensive protocols), biweekly sessions for 3 to 6 months (moderate protocols), or monthly maintenance sessions after an initial intensive course.

Safety Considerations

10-pass ozone therapy carries the same general safety considerations as standard MAH (which has a well-established safety record when performed by trained practitioners) plus some additional factors related to the higher dose and extended procedure:

• Heparin use: The anti-coagulant required for the multi-pass procedure introduces a small additional risk. Patients with bleeding disorders or on blood-thinning medications need careful evaluation.
• Herxheimer reactions: These are more common and potentially more intense with 10-pass than with standard MAH, particularly in patients with heavy infectious or toxic burden.
• G6PD deficiency: As with all ozone therapy, G6PD deficiency is an absolute contraindication. This should be tested before any ozone autohemotherapy.
• Vein access: Repeated 10-pass sessions require reliable IV access with large-bore catheters, which can be challenging for patients with difficult veins.

Who should not have 10-pass ozone therapy?

Ozone therapy consensus documents, including the Madrid Declaration on Ozone Therapy, list several conditions that rule out or call for caution with ozone autohemotherapy. With 10-pass, the heparin and the large total blood volume add a few more. Discuss these with the treating clinician before booking:

• G6PD deficiency (favism): red blood cells cannot handle oxidative stress, so ozonated blood can break down.
• Pregnancy: there are no safety data for 10-pass during pregnancy.
• Uncontrolled hyperthyroidism: ozone autohemotherapy is generally avoided until thyroid levels are stable.
• Low platelets, bleeding disorders or anticoagulant use: heparin adds to bleeding risk.
• Prior heparin-induced thrombocytopenia (HIT) or heparin allergy: the standard 10-pass setup depends on heparin.
• Severe anemia or unstable heart disease: repeated large draws and returns can strain circulation.

Short-term side effects reported after ozone autohemotherapy include bruising at the IV site, lightheadedness, fatigue, headache and flu-like symptoms. The guide to IV ozone therapy side effects describes how often these occur and which warning signs need prompt medical attention.

10-Pass vs. EBOO

EBOO (Extracorporeal Blood Ozonation and Oxygenation) is sometimes compared to 10-pass. EBOO filters blood through a dialysis-like membrane while exposing it to ozone, treating a larger volume of blood in a continuous flow rather than discrete passes.

A 2022 study found that ozone dialysis (EBOO-like treatment) delivers three or more times the ozone exposure compared to other forms of ozone blood treatment, including 10-pass.

Neither method has been tested against the other in a randomized trial, so the choice between them usually comes down to what a clinic offers, vein access, session length and cost. The side-by-side guide to EBOO versus 10-pass ozone goes through those differences protocol by protocol.

Is 10-Pass Ozone Therapy Worth the Cost?

10-pass ozone therapy is worth considering mainly for patients who have already tried standard MAH, noticed some benefit, and plateaued, and who can afford a course without financial strain. For a first-time ozone patient, standard MAH offers a cheaper way to learn whether ozone helps at all, at one-fifth to one-tenth of the per-session price.

A structured way to make the decision:

1. Confirm the diagnosis and the standard treatment first. For Lyme disease, multiple sclerosis or rheumatoid arthritis, 10-pass is an add-on, not a replacement for evidence-based care.
2. Try a lower-cost ozone method first if you have not. Standard MAH, or a few 3-pass or 5-pass sessions, shows how you tolerate ozone before committing to a full course.
3. Agree on what you will measure. Pick two or three symptoms or lab values and record them before treatment, then after every two or three sessions.
4. Set a stopping point. If nothing has changed after an agreed number of sessions, a well run clinic will suggest stopping rather than extending the course.
5. Price the whole course. Ask for the total, including add-ons and maintenance sessions, before the first session.

How to Find a 10-Pass Ozone Therapy Provider

Ozone therapy clinics are spread unevenly across the country, and only some of them own a true hyperbaric 10-pass device. The national directory of ozone therapy clinics in the United States lets you filter by state and city, then open each profile to see whether 10-pass, MAH or EBOO is listed. State pages such as ozone therapy providers in California and ozone clinics in New York narrow the list further.

Listing order on Regenerated.com is not paid ranking. Featured slots are clearly labeled and capped, Verified means the clinic passed credential checks rather than paying for placement, and the directory is free for patients to use. Inclusion in the directory is not an endorsement of any clinic or of 10-pass itself. The guide to Featured, Verified and organic listings explains each label.

Questions worth asking any clinic before booking 10-pass:

1. Which device do you use, and does it run under positive pressure, or do you repeat standard MAH several times?
2. How many 10-pass sessions has the clinician supervising mine performed, and who is on site during the session?
3. Do you test for G6PD deficiency and check a blood count before the first session?
4. What ozone concentration and blood volume will you use, and will you adjust them for my weight and history?
5. What is the total price of the course you are recommending, and what does it include?
6. What is your plan if I have a bleeding problem, faint or react badly during or after the session?

Frequently Asked Questions

Is 10-pass ozone therapy ten times better than standard MAH?

Not necessarily. 10-pass delivers roughly ten times the ozone dose of standard MAH, but biological responses do not scale linearly with dose, and Bocci’s work on ozone hormesis suggests benefits level off and can reverse at high doses. Some patients report gains with 10-pass that standard MAH did not give them, while others do as well on MAH. No published study directly compares clinical outcomes between the two approaches.

How many 10-pass sessions do I need?

The number of sessions depends on the condition and your response, and no standard exists. For chronic Lyme disease, practitioners commonly suggest 6 to 10 sessions as an initial course, and autoimmune courses may run longer. Some patients do a short intensive series, then periodic maintenance sessions. A careful practitioner reviews your progress and adjusts the plan as you go rather than committing you to a fixed number of sessions regardless of response.

Can I do 10-pass at home?

No. 10-pass ozone therapy requires specialized equipment costing $30,000 or more, IV access and blood handling, heparin administration, and a trained medical professional to perform the procedure safely. This is strictly a clinical treatment. If you are interested in home ozone therapy, rectal insufflation and other home-appropriate methods are available and can provide meaningful systemic ozone exposure at a fraction of the cost.

Is 10-pass safe?

10-pass has a reasonable safety record in practitioner reports when a trained clinician uses proper equipment, but it has not been studied in controlled trials. Serious adverse events appear rare in the published ozone literature. Common problems are fatigue, flu-like Herxheimer reactions and IV-site bruising. Heparin, long sessions and large blood volumes add risks that standard MAH lacks, so choose a clinician with specific 10-pass training and experience, not someone who has simply bought the device.

How much does 10-pass ozone therapy cost?

10-pass ozone therapy typically costs $800 to $2,500 per session in the United States, several times the $150 to $400 charged for a standard MAH session. Because clinics usually recommend a course of 6 to 10 sessions for chronic Lyme or autoimmune protocols, the total can reach $5,000 to $25,000. Insurance rarely pays, so ask for the full course price, including consultations, lab tests and add-ons, before starting.

Is 10-pass ozone therapy FDA approved?

No. The FDA has not approved 10-pass ozone therapy or any ozone autohemotherapy for treating disease. Federal regulation 21 CFR 801.415 calls ozone a toxic gas with no known useful medical application in specific, adjunctive or preventive therapy. Physicians who offer 10-pass in the US do so under their state license as an off-label, cash-pay procedure, which is also why insurers rarely cover it.

Related Reading

This article is part of our thorough guide to ozone therapy. For a complete overview, including the science behind how ozone works, all available delivery methods, and guidance on finding a qualified practitioner, see our pillar article: Ozone Therapy: The Complete Guide.

You may also be interested in:

• Ozone Therapy at Home, a guide to safe, cost-effective home ozone methods like rectal insufflation and ozonated water.
• Ozone therapy for Lyme disease, which covers how ozone is combined with antibiotics and other Lyme protocols.