Inhaled Nitric Oxide Therapy – Commercial and Individual Exchange Medical Policyopen_in_new

UnitedHealthcare covers inhaled nitric oxide (iNO) for term/near‑term infants (≥34 weeks gestation) with hypoxic respiratory failure or echocardiographic PPHN when congenital diaphragmatic hernia (CDH) is absent and conventional treatments have failed, and as bridge therapy for postoperative pulmonary hypertension in infants; iNO is not covered for preterm infants <34 weeks, newborns with CDH, individuals outside infancy (experimental/investigational), and is contraindicated for infants dependent on right‑to‑left shunting. Coverage requires documentation of gestational age, clinical diagnosis and echo evidence of PPHN, failure of conventional therapies (e.g., mechanical ventilation), absence of CDH (or rationale), monitoring data (OI/PaO2), and use of FDA‑cleared delivery/monitoring systems.

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