MedicaidCoverageMedium impact
Inhaled Nitric Oxide - MEDICAID - OKLAHOMA (Revised)
Humana·OK · Pediatrics, Cardiology, Pulmonology +1 more·Pharmacy
Effective date
Jan 1, 2025
We identified it
Jun 24, 2026
Summary
New Humana Medicaid Oklahoma policy establishes coverage criteria for inhaled nitric oxide (iNO) for specific conditions including persistent pulmonary hypertension in newborns, post-operative pulmonary hypertension in pediatric heart patients, and vasoreactivity testing in adults with pulmonary arterial hypertension. All other uses are considered not medically necessary.
Action Required
By January 30, 2026: Billing team must update prior authorization protocols for inhaled nitric oxide (iNO) claims to verify patients meet specific coverage criteria: term/near-term infants (≥34 weeks gestation) with PPHN, pediatric patients with post-operative pulmonary hypertension from congenital heart disease, or adults requiring vasoreactivity testing for PAH. Document absence of congenital diaphragmatic hernia and failure of conventional therapy. Claims not meeting these criteria will be denied as not medically necessary.