MedicaidPrior AuthMedium impact
Inhaled Nitric Oxide - MEDICAID - KENTUCKY (Revised)
Humana·KY · Pulmonology, Pediatrics, Cardiology +1 more·Pharmacy
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
Humana Kentucky Medicaid has established a new policy for inhaled nitric oxide (iNO) coverage requiring prior authorization for all uses. Coverage is limited to specific conditions: postoperative pulmonary hypertension in infants/children with congenital heart disease, vasoreactivity testing in adults with PAH, and hypoxic respiratory failure with PPHN in term/near-term infants (with strict criteria including maximum 14-day treatment duration).
Action Required
Immediately: Billing team must obtain prior authorization for all inhaled nitric oxide treatments (CPT 93463) for Kentucky Medicaid patients. Update billing system to flag these cases and ensure documentation meets specific criteria: gestational age ≥34 weeks for infants, evidence of PPHN, failure of conventional therapy, absence of congenital diaphragmatic hernia, and maximum 14-day treatment duration. Claims will be denied without proper prior authorization.