Nitric Oxide, Inhalational (INO)

Aetna covers inhaled nitric oxide (INO) using FDA‑approved devices for hypoxic respiratory failure in neonates ≥34 weeks gestation (without congenital diaphragmatic hernia) after failure or expected failure of conventional therapies, for post‑operative pulmonary hypertensive crisis in infants/children with congenital heart disease, and diagnostically to assess pulmonary vasoreactivity. Use beyond 4 days requires medical‑necessity review, therapy is generally limited to ≤14 days if oxygenation is resolved (medical director review for >14 days), and INO is experimental/investigational (not covered) for other indications including acute bronchiolitis, acute hypoxemic respiratory failure in children/adults, and acute pulmonary embolism.

"Aetna considers inhaled nitric oxide (INO) therapy medically necessary as a component of the treatment of hypoxic respiratory failure in neonates 34 weeks gestation or greater when both of the foll..."