Inhaled nitric oxide may be considered medically necessary as a component of treatment of:
Hypoxic respiratory failure in neonates born at more than 34 weeks of gestation.
Other indications for inhaled nitric oxide are investigational, including, but not limited to:
Treatment of premature neonates born at less than or equal to 34 weeks of gestation with hypoxic respiratory failure;
Treatment of adults and children with acute hypoxemic respiratory failure;
Postoperative use in adults and children with congenital heart disease;
In lung transplantation, during and/or after graft reperfusion.
