Inhaled Nitric Oxide - MEDICAID - KENTUCKY

This policy covers inhaled nitric oxide (iNO) therapy for treatment of hypoxic respiratory failure associated with persistent pulmonary hypertension of the newborn (PPHN), as well as select uses such as postoperative pulmonary hypertension in infants and children and acute vasoreactivity testing during right heart catheterization. Coverage is generally limited to term or near‑term neonates (≥34 weeks gestation through 28 days) without congenital diaphragmatic hernia after conventional therapies have failed or are expected to fail, with a maximum treatment duration of 14 days (or until oxygenation is resolved), and vasoreactivity testing must be performed in the setting of RHC.

"Postoperative pulmonary hypertension indication is specified for infants and children (implying this pediatric postoperative population is the described clinical scenario)."

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