INOmax - California Medicaid Alert

Ikaria^® is pleased to announce that the California State Medicaid program (known as Medi-Cal) has collaborated with the California Children's Hospital Association (CCHA) and California Medical Assistance Commission (CMAC) to develop a hospital payment policy for inhaled nitric oxide therapy in neonates (commercially available a INOmax (nitric oxide) for inhalation). INOmax, in conjunction with ventilatory support and other appropriate agents, is indicated for the treatment of term and near-term (>34 weeks) neonates with hypoxic respiratory failure associated with clinical or echocardiographic evidence of pulmonary hypertension, where it improves oxygenation and reduces the need for extracorporeal membrane oxygenation (ECMO).


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Selective Provider Contracting Program (SPCP) hospitals are now eligible to negotiate with CMAC for inhaled nitric oxide services if the SPCP hospital has a neonatal intensive care unit (NICU) approved by California Children's Services (CCS) as a Regional NICU and the hospital has a CCS-approved Neonatal ECMO Center.

If the hospital's SPCP contract includes designated reimbursement for inhaled nitric oxide services, the hospital must submit a separate claim for inhaled nitric oxide services using Revenue Code 174 (Nursery, Newborn; Level IV) in conjunction with ICD-9-CM Volume 3 procedure code 00.12 (Administration of inhaled nitric oxide). The number of Medi-Cal reimbursement days for inhaled nitric oxide services is based on the terms of the hospital's SPCP contract. Inhaled nitric oxide services may not be billed with any other revenue/sick baby code and must be billed on a separate claim. Inhaled nitric oxide services should not be included on the mother's claim or on the same claim with any other service.

If the hospital needs to bill for inhaled nitric oxide services, ECMO, and NICU, each of the three services (even though all were rendered in the NICU) must be billed on separate CMS-1450 UB-92 claim forms (or its electronic equivalent) in order for the system to adjudicate the claims correctly. For example, along with revenue code 174 (Nursery, Newborn; Level IV):

•  The inhaled nitric oxide services claim must use ICD-9-CM Volume 3 procedure code 00.12,
•  The ECMO claim must use ICD-9-CM Volume 3 procedure code 39.65, and
•  The NICU claim will reflect all appropriate ICD-9-CM diagnosis and procedure codes.

The downloadable sample UB-92 (paper claim) illustrates how to complete form locators (FLs) 42, 43, 46, 47 and 80 for inhaled nitric oxide services. Please note that this example does not include all information required by Medi-Cal.

The information provided in this document is for educational purposes only and is not intended to serve as reimbursement or legal advice. This information is based on the stated assumptions and is current as of January 21, 2005. Reimbursement information is subject to change at any time, so you should check with your specific payers to ensure that you have the most up-to-date information applicable to them. It is each provider's responsibility to determine whether the services actually provided are accurately described by any specific code(s) and to report those services consistent with specific payer requirements. Ikaria^® recommends that you consult with your reimbursement advisor, legal counsel and/or payer representatives with any questions regarding appropriate coding and reporting of INOmax and INOtherapy®. In all cases, services billed must be medically necessary, actually performed as reported and appropriately documented.

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For complete INOmax prescribing information, CLICK HERE

Information intended for the United States. For information outside the US CLICK HERE