MedicaidCoverageMedium impact
Inhaled Nitric Oxide - MEDICAID - SOUTH CAROLINA (Revised)
Humana·SC · Pediatrics, Cardiology, Critical Care +1 more·Pharmacy
Effective date
Sep 6, 2025
We identified it
Jun 24, 2026
Summary
Humana Medicaid South Carolina has established a new policy for inhaled nitric oxide (iNO) coverage with specific criteria for term/near-term infants with PPHN, postoperative pulmonary hypertension in children with congenital heart disease, and vasoreactivity testing in adults with PAH. Coverage requires meeting strict medical necessity criteria and is limited to a maximum 14-day treatment duration for PPHN cases.
Action Required
Before September 6, 2025: Billing teams must review inhaled nitric oxide claims for Humana Medicaid SC members to ensure they meet specific coverage criteria including term/near-term infant status (≥34 weeks gestation), failure of conventional therapy, absence of congenital diaphragmatic hernia, and maximum 14-day treatment duration. Update prior authorization processes to verify these requirements as claims not meeting criteria will be denied as not medically necessary.