Notice Date: April 1, 2026 To: CareSource Next Generation MyCare OH FIDE Providers From: CareSource Subject: April 2026 Policy Updates Effective Date: June 1, 2026 Summary At CareSource, we listen to our providers, and we streamline our business practices to make it easier for you to work with us. We have worked to create a predictable cycle for releasing administrative, medical, and reimbursement policies, so you know what to expect. Check back each month for a consolidated network notification of policy updates from CareSource. How to Use This Network Notification Reference the list of policy updates. Note the effective date and impacted plans for each policy. Click the hyperlinked policy title to open the webpage with the full policy. Find Our Policies Online To access all CareSource policies, visit CareSource.com > Providers > Tools & Resources > Provider Policies. Select your plan and state, then the type of policy. Each revised policy has a previous version that can be referenced on the corresponding archived policy webpage. Policies Policy Name & Number Policy Type Plan Effective Date New or Revised?Program Integrity Provider Prepayment Review AD-1582 ADMINISTRATION OHIO MYCARE FIDE JUNE1, 2026 REVISIONH6396_OH-SNP-P-5345250_C
Notice Date: April 1, 2026 To: Ohio Marketplace Providers From: CareSource Subject: April 2026 Policy Updates Effective Date: June 1, 2026 and July 1, 2026 Summary At CareSource, we listen to our providers, and we streamline our business practices to make it easier for you to work with us. We have worked to create a predictable cycle for releasing administrative, medical, and reimbursement policies, so you know what to expect. Check back each month for a consolidated network notification of policy updates from CareSource. How to Use This Network Notification Reference the list of policy updates. Note the effective date and impacted plans for each policy. Click the hyperlinked policy title to open the webpage with the full policy. Find Our Policies Online To access all CareSource policies, visit CareSource.com > Providers > Tools & Resources > Provider Policies. Select your plan and state, then the type of policy. Each revised policy has a previous version that can be referenced on the corresponding archived policy webpage. Policies Policy Name & Number Policy Type Plans Effective DateNew or Revised Policy?Modifier 26 and TC Professional and Technical Component PY-1475 REIMBURSEMENT MARKETPLACE JUNE 1, 2026 REVISION Dental Procedures Rendered in a Hospital or Ambulatory Surgery Center PY-1407 REIMBURSEMENT MARKETPLACE JUNE 1, 2026 REVISION E/M Preventive and Acute Care Visit on Same Date of Service PY-1388 REIMBURSEMENT MARKETPLACE JUNE 1, 2026 REVISION Evaluation and Management (E/M) and Psychotherapy PY-1776 REIMBURSEMENT MARKETPLACE JUNE 1, 2026 NEW Evaluation and Management Services and Urinalysis PY-1609 REIMBURSEMENT MARKETPLACE JUNE 1, 2026 REVISION G2211 Reimbursement PY-1779 REIMBURSEMENT MARKETPLACE JULY 1, 2026 NEW Genetic Testing and Counseling MM-1322 MEDICAL MARKETPLACE JUNE 1, 2026 REVISION Infusion & Injection Administration PY-1770 REIMBURSEMENT MARKETPLACE JUNE 1, 2026 NEW Mechanical Stretching Devices MM-1382 MEDICAL MARKETPLACE JUNE 1, 2026 REVISION Modifier 25 PY-1363 REIMBURSEMENT MARKETPLACE JUNE 1, 2026 REVISION Program Integrity Provider Prepayment Review AD-1222 ADMINISTRATIVE MARKETPLACE JUNE 1, 2026 REVISION Transcranial Magnetic Stimulation for Treatment of Depression MM-1339 MEDICAL MARKETPLACE JUNE 1, 2026 REVISION OH-EXC-P-5331050
CLAIM TYPE:___ UB-04 ___ HCFA-1500 ___ ADA CLAIM DISPUTE REASON (SELECT THE MOST APPROPRIATE) Incorrect Payment Author ization Overpayment Clinical Edit Procedure Dispute Eligibility Consent Form Timely Filing Coordination of Benefits Recoupm ent Provider ID Dispute Duplicate Claim Open NegotiationDescription of dispute and expected outcome: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Provider Standard Claims Dispute FormPATIENT INFORMATION DATE OF SERVICE:AUTHORIZATION #:NAME: DATE OF BIRTH:CARESOURCE ID #: TO SUBMIT CLAIMS DISPUTESMail –
CareSource.com Standard Appeal FormThe preferred method of submission is to submit all appeals through the CareSource Provider Portal , however, if you are unable to do so, please complete the following form and submit to the mailing address below. PATIENT INFORMATION DATE OF SERVICE: _________________AUTHORIZATION NUMBER: NAME: CARESOURCE ID NUMBER: DATE OF BIRTH: ___________________ CLAIM NUMBER: _____________________________________ PROVIDER INFORMATION PROVIDER NPI : PROVIDER TAX ID NUMBER : PROVIDER NAME : REQUESTOR NAME: REQUESTOR EMAIL : REQUESTOR PHONE : REQUESTOR ADDRESS : PREFERRED METHOD OF COMMUNICATION : EMAIL PHONE POSTAL MAIL SERVICE INFORMATION What service denial is being appealed: __________________________________________________ _________________________________________________________________________________Explain why this service is needed:_____________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ For any questions, please call 1-833-230-2112. We are open Monday to Friday from 8 a.m. to 6 p.m., Pacific Time (PT). Mail CareSource, Attention: Nevada Medicaid Provider , P.O. Box 2008, Dayton, OH 45401 When submitting the form, include documentation which supports the appeal , including but not limited all medical records that will need to be reviewed. If an incomplete appeal is submitted, the provider will receive a notification indicating the request is incomplete. NV-MED-P-4013802
________________________________________________________________________________________________________________________________________________ Mississippi Medicaid2025 Interoperability Prior Authorization Report Standard Prior Authorizations by Status DECISION REQUESTS PERCENTAGE Approved 29,726 86% Denied 4,654 14% Approved After Timeframe Extension 0 0% Approved After Appeal 53 23% Turnaround Time for Standard Prior Authorizations ( Target 2 Days)Time Between Receiving a Request and Sending a DecisionMEDIAN AVERAGE1 day 1 day Expedited Prior Authorizations by StatusDECISION RE QUESTS PERCENTAGEApproved 938 95% Denied 51 5% Approved After Timeframe Extension 0 0% Approved After Appeal 1 17% Time for Expedited Prior Authorizations ( Target 24 Hour s)Time Between Receiving a Request and Sending a DecisionMEDIAN AVERAGE18 Hours 20 Hours MS-MED-5008650 Approved:
Notice Date: March 27, 2026 To: Arkansas PASSE Providers From: CareSource PASSE Subject: Cultural Competency Effective Date: March 27, 2026 Summary At CareSource PASSE we are committed to creating resources that empower health care providers to meet the diverse needs of their patients while maintaining professionalism and respect. Our mission is to promote positive health outcomes, ensuring that every individual can achieve optimal health by eliminating barriers to care. Cultural Influences on Health Care Delivery Cultural factors, including language, beliefs, values, and behaviors, influence how individuals perceive illness and interact with the health care system. Education, lived experience, and spiritual beliefs may further affect health-related decisions. Recognizing and addressing cultural differences is essential to improving communication, supporting treatment adherence, and reducing the risk of m isunderstanding or non-compliance. Addressing Gaps in Access to Care Differences in access to health care are impacted by unequal social, economic, and environmental conditions. Achieving fairness in access requires the identification and removal of barriers related to race, ethnicity, gender, religion, socioeconomic status , disability, and geographic location. Addressing gaps in access to care promotes improved health outcomes, stronger communities, and a more sustainable health care system. Cultural Competency Resources We recognize our responsibility to provide educational resources that support our providers and community partners ability to deliver effective and culturally appropriate care, helping us reach our goal to reduce and ultimately eliminate the barriers in health care access and optimal health outcomes that adversely affect our members. Providers can access a variety of cultural competency resources on our websites: Cultural Competency in Health Care : This training resource enhances cultural and disability competency, enabling providers to effectively address the health needs of all patients. This training can be found within our Learning Management System (LMS) at HealthPlanResources.com . Free activities via CME Outfitters : Through our partnership with CME Outfitters, you can earn over 10 hours of free CME/CE credit by visiting Addressing Access to Health Care. Additional details about available resources are also included in our provider manual. Prevalent Non-English Languages To effectively support our patient population, it is essential to recognize the cultural and linguistic needs of our communities. Here are the top 10 non-English languages spoken by residents in the state of Arkansas : Spanish Vietnamese French German Lao Tagalog Telugu Portuguese Ta m i l Arabic Source: US Census ACS (American Community Survey) 1-Year Estimates Public Use Microdata Sample | reaLanguage other than English spoken at home (LANP) Language Support Services Language assistance services during health encounters are provided at no cost to members and providers with limited English proficiency and to those with hearing, speech, or visual impairments. Available services include: Telephone interpretation during business hours through Member and Provider Services After-hours interpretation via the 24-Hour Nurse Advice Line listed on the member ID card Face-to-face interpreters, including sign language interpreters, upon request via Propio For more information, please visit propio.com/welcome-caresource-providers/ TTY and relay services via the number on the member ID card or by dialing 711 Please note: Interpreter requests should be submitted at least three business days in advance. Cancellations require 24 business hours notice. Provider Responsibility Providers are expected to utilize available cultural competency and language access resources to support effective communication, ensure compliance with applicable regulations, and foster respectful, patient-centered care. Questions? Contact your Health Partner Engagement Specialist or Provider Services at 1-833-230-2100. You can also review our Health and Social Part nerships and Quality Improvement webpages. AR-PAS-P-5260235
ADMINISTRATIVE POLICY STATEMENTIndiana Medicaid Policy Name & Number Date Effective Electrocardiogram (EKG/ECG) Interpretation and Imaging Interpretation – IN MCD-AD-1092 06/01/2026 Policy Type ADMINISTRATIVE Administrative Policy Statement prepared by CareSource and its affiliates are derived from literature based on and supported by clinical guidelines, nationally recognized utilization and technology assessment guidelines, other medical management industr y standards, and published MCO clinical policy guidelines. Medically necessary services include, but are not limited to, those health care services or supplies that are proper and necessary for the diagnosis or treatment of disease, illness, or injury and without which the patient can be expected to suffer prolonged, increased or new morbidity, impairment of function, dysfunction o f a body organ or part, or significant pain and discomfort. These services meet the standards of good medical practice in the l ocal area, are the lowest cost alternative, and are not provided mainly for the convenience of the member or provider. Medically necessary services also include those services defined in any Evidence of Coverage documents, Medical Policy Statements, Provider M anuals, Member Handbooks, and/or other policies and procedures. Administrative Policy Statements prepared by CareSource and its affiliates do not ensure an authorization or payment of services. Please refer to the plan contract (often referred to as the Evidence of Coverage) for the service(s) referenced in the Adminis trative Policy Statement. If there is a conflict between the Administrative Policy Statement and the plan contract (i.e., Evidence of Coverage), then the plan contract (i.e., Evidence of Coverage) will be the controlling document used to make the determina tion. According to the rules of Mental Health Parity Addiction Equity Act (MHPAEA), coverage for the diagnosis and treatment of a behavioral health disorder will not be subject to any limitations that are less favorable than the limitations that apply to medical conditions as covered under this policy.Table of ContentsA. Subject ………………………….. ………………………….. ………………………….. …………………………. 2 B. Background ………………………….. ………………………….. ………………………….. …………………… 2 C. Definitions ………………………….. ………………………….. ………………………….. ……………………… 2 D. Policy ………………………….. ………………………….. ………………………….. ………………………….. .. 2 E. Conditions of Coverage ………………………….. ………………………….. ………………………….. …… 3 F. Related Policies/Rules ………………………….. ………………………….. ………………………….. …….. 3 G. Review/Revision History ………………………….. ………………………….. ………………………….. ….. 3 H. References ………………………….. ………………………….. ………………………….. ……………………. 3 Electrocardiogram (EKG/ECG) Interpretation and ImagingInterpretation-IN MCD-AD-1092Effective Dat e: 06/01/2026 The ADMINISTRATIVE Policy Statement detailed above has recei ved due consideration as defined in theADMINISTRATIVE Policy Statement Policy and is approved.2 A. SubjectElectrocardiogram (EKG/ECG) Interpretation and Imaging Interpretation B. BackgroundAn electrocardiogram (EKG/ECG) is a non-invasive test that records the electrical activity of the heart and is often used when a possible cardiac issue occurs . The recording is reviewed by a qualified provider who provides an interpretation and written report. An EKG/ECG may be reported as the technical aspect only, the interpretation and written report only, or both aspects together as one serv ice. For the purpose of this policy, EKG will be used to represent both EKG and ECG. C. Definitions Electrocardiogram (EKG/ECG) A test that records the electrical activity of the heart. Imaging Several different technologies that are used to view the human body in order to diagnose, monitor, or treat medical conditions. D. PolicyI. Electrocardiogram (EKG/ECG) Interpretation A. CareSource will reimburse the first EKG interpretation claim that is received for the member on the date of service. 1. If another claim for the same EKG interpretation is received for reimbursement, CareSource will only reimburse the first claim received for the same member on the same date of service. 2. CareSource will not reimburse for duplicate claims for the same service on the same date of service for the same member without the appropriate modifier. B. If a second EKG interpretation is medically necessary on the same date of service before the member is discharged, modifier 76 or modifier 77 must be appended to the second EKG interpretation for reimbursement. II. Imaging InterpretationA. CareSource will reimburse the first imaging interpretation claim that is received for the member on the date of service. 1. If another claim for the same imaging interpretation is received for reimbursement, CareSource will only reimburse the first claim received for the same member on the same date of service. 2. CareSource will not reimburse for duplicate claims for the same service on the same date of service for the same member without the appropriate modifier. Electrocardiogram (EKG/ECG) Interpretation and ImagingInterpretation-IN MCD-AD-1092Effective Dat e: 06/01/2026 The ADMINISTRATIVE Policy Statement detailed above has recei ved due consideration as defined in theADMINISTRATIVE Policy Statement Policy and is approved.3 B. If a second imaging interpretation is medically necessary on the same date of service before the member is discharged, modifier 76 or modifier 77 must be appended to the second imaging interpretation for reimbursement. III. CareSource expects providers to work with other departments within the provider organization to determine which department will submit the claim to prevent duplicate claim submissions. E. Conditions of CoverageCareSource expects provider to use appropriate standard billing guidelines. Modifiers are listed below only as a reference. Modifier Description 76 Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional 77 Repeat Procedure by Another Physician or Other Qualified Health Care Professional Imaging ModifiersModifier Description26 Professional Component TC Technical component F. Related Policies/RulesN/A G. Review/Revision HistoryDATES ACTIONDate Issued 03/31/2021 New policyDate Revised 09/14/2022 09/13/2023 01/29/202503/23/2026No changes to content. Edited definition wording. Removed place of service language. Updated references. Approved at Committee. Annual review . Updated background, definition, and references. Added Imaging modifiers. Approved at Committee. Annual review. Updated references. Approved at Committee. Date Effective 06/01/2026 Date Archived H. References1. Hussain S, Mubeen I, Ullah N, et al. Modern diagnostic imaging technique applications and risk factors in the medical field: a review. Biomed Res Int . 2022;5164970. doi:10.1155/2022/5164970 2. Sattar Y, Chhabra L. Electrocardiogram . StatPearls Publishing; 2025. Updated January 2025. Accessed December 11, 2025 . www.ncbi.nlm.nih.gov Electrocardiogram (EKG/ECG) Interpretation and ImagingInterpretation-IN MCD-AD-1092Effective Dat e: 06/01/2026 The ADMINISTRATIVE Policy Statement detailed above has recei ved due consideration as defined in theADMINISTRATIVE Policy Statement Policy and is approved.4 3. Medical Imaging. US Food and Drug Administration. Published August 28, 2018. Accessed December 11, 2025 . www.fda.gov4. What are medical coding modifiers? American Academy of Professional Coders. Updated August 19, 2022. Accessed December 11, 2025 . www.aapc.com IN-MED-P-5010101 Issue date 03/31/202 Approved OMPP 03/23/2026
_______________________________________________________________________________________________________________________________________________ Michigan Marketplace 2025 Interoperability Prior Authorization Report Standard Prior Authorizations by Status DECISION RE QUESTS PERCENTAGE Approved 10,379 72% Denied 3,962 28% Approved After Timeframe Extension 0 0% Approved After Appeal 65 30% Turnaround Time for Standard Prior Authorizations (Target 7 Days)Time Between Receiving a Request and Sending a DecisionMEDIAN AVERAGE4 days 4 days Expedited Prior Authorizations by StatusDECISION REQ UESTS PERCENTAGEApproved 287 80% Denied 73 20% Approved After Timeframe Extension 0 0% Approved After Appeal 9 41% Turnaround Time for Expedited Prior Authorizations (Target 72 Hours)Time Between Receiving a Request and Sending a DecisionMEDIAN AVERAGE29 Hours 34 Hours MI-EXC-P -4923500
________________________________________________________________________________________________________________________________________________ Ohio Dual Special Needs Plan (D-SNP)2025 Interoperability Prior Authorization Report Standard Prior Authorizations by Status DECISION REQUESTS PERCENTAGE Approved 21,098 90% Denied 2,486 10% Approved After Timeframe Extension 0 0% Approved After Appeal 195 25% Turnaround Time for Standard Prior Authorizations ( Target 10 Days)Time Between Receiving a Request and Sending a DecisionMEDIAN AVERAGE2 days 5 daysExpedited Prior Authorizations by StatusDECISION REQUESTS PERCENTAGE Approved 616 86% Denied 105 14% Approved After Timeframe Extension 0 0% Approved After Appeal 28 50% Turnaround Time for Expedited Prior Authorizations ( Target 48 Hours)Time Between Receiving a Request and Sending a DecisionMEDIAN AVERAGE3 hours 30 h ours Y0019_OH-DSNP-P -4916250_C
MEDICAL POLICY STATEMENTIndiana Medicaid Policy Name & Number Date Effective Inhaled Nitric Oxide-IN MCD-MM-1186 06/01/2026 Policy Type MEDICAL Medical Policy Statement prepared by CareSource and its affiliates are derived from literature based on and supported by clin ical guidelines, nationally recognized utilization and technology assessment guidelines, other medical management industry standard s, and published MCO clinical policy guidelines. Medically necessary services include, but are not limited to, those health care services or supplies that are proper and necessary for the diagnosis or treatment of disease, illness, or injury and without w hich the patient can be expected to suffer prolonged, increased or new morbidity, impairment of function, dysfunction of a body organ or part, or significant pain and discomfort. These services meet the standards of good medical practice in the local area , are the lowest cost alternative, and are not provided mainly for the convenience of the member or provider. Medically necessary services also include those services defined in any Evidence of Coverage documents, Medical Policy Statements, Provider Manua ls, Member Handbooks, and/or other policies and procedures. Medical Policy Statements prepared by CareSource and its affiliates do not ensure an authorization or payment of services. Please refer to the plan contract (often referred to as the Evidence of Coverage) for the service(s) referenced in the Medical Polic y Statement. If there is a conflict between the Medical Policy Statement and the plan contract (i.e., Evidence of Coverage), then the plan contract (i.e., Evidence of Coverage) will be the controlling document used to make the determinatio n. According to the rules of Mental Health Parity Addiction Equity Act (MHPAEA), coverage for the diagnosis and treatment of a behavioral health disorder will not be subject to any limitations that are less favorable than the limitations that apply to medical conditions as covered under this policy.Table of ContentsA. Subject ………………………….. ………………………….. ………………………….. ………………………….. 2 B. Background ………………………….. ………………………….. ………………………….. ……………………. 2 C. Definitions ………………………….. ………………………….. ………………………….. ………………………. 7 D. Policy ………………………….. ………………………….. ………………………….. ………………………….. … 8 E. Conditions of Coverage ………………………….. ………………………….. ………………………….. ……. 9 F. Related Policies/Rules ………………………….. ………………………….. ………………………….. ……… 9 G. Review/Revision History ………………………….. ………………………….. ………………………….. …… 9 H. References ………………………….. ………………………….. ………………………….. …………………….. 9 Inhaled Nitric Oxide-IN MCD-MM-1186Effective Dat e: 06/01/2026The MEDICAL Policy Statement detailed above has recei ved due consideration as defined in theMEDICAL Policy Statement Policy and is approved.2 A. SubjectInhaled Nitric Oxide (iNO) B. BackgroundInhaled Nitric oxide (iNO) is a lipophilic gas that is naturally produced in numerous cells in the body and is readily absorbed across pulmonary membranes in the ventilated lung after inhalation. In the body, nitric oxide is involved in oxygen transport to the tissues, the transmission of nerve impulses, and other physiological activities. When administered via inhalation, it is a potent endogenous vasodilator that induces relaxation of vascular and bronchial smooth muscle, vasodilation of blood vessels, and can increase the partial pressure of arterial oxygen. iNO was initially approved by the U SFood and Drug Administration (FDA) in 1999. A complete nitric oxide delivery system is comprised of a nitric oxide administration apparatus, a nitric o xide gas analyzer, and a nitrogen dioxide gas analyzer. Additional warnings and precautions were added in 2013, including rebound hypertension following abrupt discontinuation, hypoxia from methemoglobinemia , and airway injury from nitrous dioxide. Dilation of pulmonary vessels in well-ventilated lung areas redistributes blood flow awayfrom lung areas where ventilation/perfusion ratios are poor. iNO has been used in conjunction with ventilator support as a treatment of hypoxic respiratory failure associated with persistent pulmonary hypertension of the newborn (PPHN), in infants who are at term or near-term (greater than 34 weeks gestation) to improve oxygenation,and to decrease the need for extracorporeal membrane oxygenation (ECMO). Respiratory failure is a clinical state that is defined either by the inability to rid the bodyof carbon dioxide or establish an adequate blood oxygen level. Acute respiratory failure is the most common clinical problem seen in term, near-term (born at 34 or more weeks of gestation), and pre-term (less than 34 weeks of gestation) infants admitted to neonatal intensive care units. Acute respiratory failure is frequently associated with meconium aspiration syndrome, sepsis, pulmonary hypoplasia, and/or prima ry pulmonary hypertension of the newborn. Management of infants with respiratory failure includes administration of high concentrations of oxygen, hyperventilation, high-frequency ventilation, neuromuscularblockade, antenatal steroids for the prevention of respiratory distress syndrome, use of po st-natal steroids to decrease inflammation, as well as iNO therapy.Clinical studies have shown that iNO is a selective pulmonary vasodilator without significant effects on the systemic circulation. There is scientific evidence that iNO therapy improves oxygenation and ventilation, reduces the need for extracorporealmembrane oxygenation (ECMO), and lowers the incidences of chronic lung disease and death among infants with respiratory failure. Moreover, the literature indicates that iNO does not appear to increase the incidence of adverse neurodevelopmental, behavioral, or medical sequelae in these high-risk neonates. Infants with congenital diaphragmatic hernia (CDH) have not been shown to benefit from iNO therapy. Clark, et al (2000) Inhaled Nitric Oxide-IN MCD-MM-1186Effective Dat e: 06/01/2026The MEDICAL Policy Statement detailed above has recei ved due consideration as defined in theMEDICAL Policy Statement Policy and is approved.3 concluded iNO does not lead to reduced ECMO use and Putnam, et al (2016) concluded iNO use in CDH may be associated with increased mortality.In preterm infants, the most common cause of acute respiratory failure is respiratory distress syndrome as a result of surfactant deficiency. According to the available literature, treatment of preterm infants usually entails exogenous surfactant administr ation. A systematic review of the evidence (Barrington and Finer, 2003)concluded: “The currently published evidence from randomized trials does not support the use of inhaled nitric oxide in preterm infants with hypoxic respiratory failure.” Carey, et al (2018) also concluded, Off-label prescription of iNO is not associated with reduced in-hospital mortality among premature infants with respiratory distress syndrome (RDS). In an Agency for Healthcare Research and Qualitys assessment on Inhaled Nitric Oxidein Preterm Infants , Allen, et al (2010) systematically reviewed the evidence on the use of iNO in preterm infants born at or before 34 weeks gestation age who receive respiratory support. They searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Studies (CENTRAL) and PsycInfo in June 2010. They also searched the proceedings o f the 2009 and 2010 Pediatric Academic Societies Meeting and ClinicalTrials.gov. T hey identified additional studies from reference lists of eligible articles and relevant reviews, as well as from technical experts. Questions were developed in collaboration with technical experts, including the chair of the upcoming National Institutes o f Health Office of Medical Applications of Research Consensus Development Conference. These researchers limited their review to randomized controlled trials (RCTs) for the question of survival or occurrence of bronchopulmonary dysplasia (BPD), and for the question on short-term risks. All study designs were considered for long-term pulmonary or neurodevelopmental outcomes, and for questions about whether outcomes varied by sub population or by intervention characteristics. Two investigators independently screened search results and abstracted data from eligible articles. These investigators identified a total of 14 RCTs, reported in 23 articles, and 8 observational studies. Chro nic Lung Disease (CLD) or BPD studies have shown that there is insufficient evidence to support iNO for the treatment of CLD or BPD. Mortality rates in the neonatal intensive care unit (NICU) did not differ for infants treatedwith iNO versus those not treated with iNO (RR 0.97 (95 % CI: 0.82 to 1.15)). Broncho-pulmonary dysplasia at 36 weeks for iNO and control groups also did not differ (RR 0.93 (0.86, 1.003) for survivors). A small difference was found between iNO and control infants in the composite outcome of death or BPD (RR 0.93 (0.87, 0.99)). There was inconsistent evidence about the risk of brain injury from individual RCTs, bu t meta – analyses showed no difference between iNO and control groups. These researchers found no evidence of differences in other short-term risks. There was no evidence to suggest a difference in the incidence of cerebral palsy (RR 1.36 (0.88, 2.10)), neu rodevelopmental impairment (RR 0.91 (0.77, 1.12)), or cognitive impairment (RR 0.72 (0.35, 1.45)). Evidence was limited on whether the effect of iNO varies by subpopulation or by characteristics of the therapy (timing, dose and duration, mode of delivery, or concurrent therapies). The authors concluded that there was a 7% reduction Inhaled Nitric Oxide-IN MCD-MM-1186Effective Dat e: 06/01/2026The MEDICAL Policy Statement detailed above has recei ved due consideration as defined in theMEDICAL Policy Statement Policy and is approved.4 in the risk of the composite outcome of death or BPD at 36 weeks PMA for infants treated with iNO compared to controls, but no reduction in death or BPD alone. They stated that further studies are needed to explore subgroups of infants and to assess long-term outcomes including function in childhood. There is currently no evidence to support the use of iNO in preterm infants with respiratory failure outside the context of rigorously conducted RCTs. To provide health care professionals, families, and the general public with a responsible assessment of currently available data regarding the benefits and risks of iNO in premature infants, the Eunice Kennedy Shriver National Institute of Child Health andHuman Development, the National Heart, Lung, and Blood Institute, and the Office of Medical Applications of Research of the National Institutes of Health (Cole, et al, 2011) convened a consensus-development conference. Findings from a substantial body of experimental work in developing animals and other model systems suggest that iNO may enhance lung growth and reduce lung inflammation independently of its effects on blood vessel resistance. Although this work demonstrates biological plausibility and the results of RCTs in term and near-term infants were positive, combined evidence from the 14 RCTs of iNO treatment in premature infants of gestation of 34 weeks or less shows equivocal effects on pulmonary outcomes, survival, and neurodevelopmental outcomes. A National Institutes of Health Consensus Development Conference for inhaled nitricoxygen in premature infants (Cole, et al, 2010) recommended the following:1. Taken as a whole, the available evidence does not support use of iNO in early routine, early rescue, or later rescue regimens in the care of premature infants
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