MedicaidCoverageMedium impact
Inhaled Nitric Oxide - MEDICAID - VIRGINIA (Revised)
Humana·VA · Cardiology, Critical Care, Pediatrics +2 more·Pharmacy
Effective date
Jan 7, 2026
We identified it
Jun 24, 2026
Summary
Humana Virginia Medicaid has established a new coverage policy for inhaled nitric oxide (iNO) therapy, covering specific indications including postoperative pulmonary hypertension management in pediatric patients with congenital heart disease, vasoreactivity testing in adults with pulmonary arterial hypertension, and hypoxic respiratory failure in term/near-term infants with PPHN when conventional therapy has failed.
Action Required
Before January 7, 2026: Billing team must update prior authorization processes for inhaled nitric oxide therapy (CPT 93463) for Virginia Medicaid patients. Ensure documentation includes gestational age ≥34 weeks for neonates, evidence of PPHN, failure of conventional therapy, absence of congenital diaphragmatic hernia, and treatment duration not exceeding 14 days. Update encounter forms to capture required clinical criteria for coverage determination.