NICU Discharge Guidelines

This policy covers NICU discharge criteria and payer coverage for related home care services and durable medical equipment—such as gavage or gastrostomy feeding, IV/enteral nutrition including TPN, home oxygen/ventilators, cardiorespiratory/pulse‑oximetry monitors, and home phototherapy—for infants transitioning from the NICU. It applies to preterm, late‑preterm and term newborns (including those with chronic lung disease, tracheostomy, or specialized nutritional/respiratory needs) and requires specific physiologic and care competencies (adequate weight gain, thermal stability off support 24–48 hours, mature respiratory control), documented caregiver training/physician agreement, completed specialty consultations and home equipment/nursing arrangements, with limits such as low‑flow O2 ≤0.5 LPM, ventilator FiO2 ≤40%, required inpatient recovery/demo periods (e.g., gastrostomy), and exclusions for non‑medical/social delays.

"Infant is medically ready for discharge when required physiologic competencies I through V are met and required care competencies VI are met."