MedicaidPrior AuthMedium impact
Inhaled Nitric Oxide - MEDICAID - OHIO (Revised)
Humana·OH · Critical Care, Cardiology, Pediatrics +1 more·Pharmacy
Effective date
Jan 30, 2026
We identified it
Jun 24, 2026
Summary
This policy establishes coverage criteria for inhaled nitric oxide (iNO) for Ohio Medicaid members, covering specific indications including persistent pulmonary hypertension in newborns, postoperative pulmonary hypertension in infants/children with congenital heart disease, and vasoreactivity testing for pulmonary arterial hypertension. Prior authorization is required with specific medical necessity documentation.
Action Required
Before January 30, 2026: Billing team must verify prior authorization requirements for inhaled nitric oxide services through the Ohio Medicaid Prior Authorization and Notification List. Providers treating Ohio Medicaid patients must ensure documentation includes specific medical necessity criteria for covered indications (PPHN in term/near-term infants, postoperative pulmonary hypertension, or PAH vasoreactivity testing). Submit authorization requests through the Humana provider portal with complete clinical documentation. Services provided without preauthorization may be subject to retrospective review and potential claim denials.