Inhaled Nitric Oxide - MEDICAID - OHIO

This policy covers inhaled nitric oxide (iNO) administration as a pulmonary vasodilator for indications such as hypoxic respiratory failure from persistent pulmonary hypertension of the newborn (PPHN), postoperative pulmonary hypertension in infants/children, acute vasoreactivity testing in pulmonary arterial hypertension, and other proposed uses including primary lung graft dysfunction and pulmonary veno‑occlusive disease. Coverage for Humana Healthy Horizons® in Ohio is determined case‑by‑case and requires prior authorization, medical‑necessity documentation and adherence to OAC Chapter 5160/FFS Medicaid rules (e.g., iNO is generally expected to be used with ventilatory support and congenital diaphragmatic hernia is excluded).

"Bronchopulmonary dysplasia (BPD), also known as neonatal chronic lung disease (CLD)"

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