MedicaidCoverageMedium impact
Inhaled Nitric Oxide - MEDICAID - MICHIGAN (New)
Humana·MI · Cardiology, Pediatrics, Pulmonology +2 more·Pharmacy
Effective date
Jan 1, 2026
We identified it
Jun 24, 2026
Summary
Humana Medicaid Michigan has established a new policy for inhaled nitric oxide (iNO) coverage effective January 1, 2026. The policy covers iNO for specific conditions including postoperative pulmonary hypertension management in pediatric congenital heart disease, vasoreactivity testing in adults with pulmonary arterial hypertension, and hypoxic respiratory failure in term/near-term infants with persistent pulmonary hypertension of the newborn, with strict criteria and a 14-day maximum treatment duration.
Action Required
Before January 1, 2026: Billing team must update prior authorization processes for inhaled nitric oxide (CPT 93463) for Humana Medicaid Michigan members. Ensure documentation includes specific covered indications (postoperative pulmonary hypertension in pediatric congenital heart disease, vasoreactivity testing for PAH in adults, or PPHN in term/near-term infants), failure of conventional therapy, absence of congenital diaphragmatic hernia when applicable, and treatment duration not exceeding 14 days. Claims for other indications will be denied as not medically necessary.