Clinical UM Guideline
Subject: Home Phototherapy Devices for Neonatal Hyperbilirubinemia
Guideline #: CG-DME-12 Publish Date: 10/01/2026
Status: Revised Last Review Date: 08/13/2026
Description

This document addresses the use of home phototherapy and the devices used for the treatment of neonatal jaundice that is physiologic (that is, non-pathologic) in nature. In utero, the fetus requires larger amounts of hemoglobin for oxygenation. After birth, the need is reduced and hemoglobin is rapidly destroyed, producing increased levels of bilirubin. Jaundice results when the neonate’s liver is unable to efficiently clear the accumulating bilirubin. Neonatal jaundice is a common occurrence and is frequently treated in the home setting. Infants with very high levels of bilirubin may be managed in the inpatient setting.

Note: For a high-level overview of this document, please see “Summary for Members and Families” below.

Clinical Indications

Medically Necessary:

Home phototherapy devices are considered medically necessary when the criteria below are met:

  1. The infant has neonatal hyperbilirubinemia; and
  2. Is ready to be discharged from the hospital or is already discharged; and
  3. Has no known hyperbilirubinemia neurotoxicity risk factors; and
  4. Total serum bilirubin concentration is no more than 1 mg/dL above the phototherapy treatment threshold as defined by the American Academy of Pediatrics Clinical Practice Guideline*; and
  5. Phototherapy equipment used in the home, such as a fiberoptic blanket or band, is provided by a durable medical equipment (DME) provider.

*American Academy of Pediatrics Clinical Practice Guideline Revision: Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation is available at: https://publications.aap.org/pediatrics/article/150/3/e2022058859/188726/Clinical-Practice-Guideline-Revision-Management-of?searchresult=1.

Not Medically Necessary:

Home phototherapy devices for neonatal hyperbilirubinemia are considered not medically necessary when the criteria above have not been met.

Home phototherapy devices for neonatal hyperbilirubinemia are considered not medically necessary when more than one phototherapy device (intensive phototherapy) is used in the home setting.

Summary for Members and Families

This document describes clinical studies and expert recommendations and explains whether home phototherapy for neonatal hyperbilirubinemia is clinically appropriate. The following summary does not replace the criteria or other information in this document. The summary may not contain all of the relevant criteria or information. This summary is not medical advice. Please check with your health care provider for any advice about your health.

Key Information

Bilirubin is a by-product of red blood cell breakdown by the liver. This process commonly has problems in newborns and results in accumulation of bilirubin in the body, resulting in a condition called newborn jaundice or neonatal hyperbilirubinemia. Phototherapy is a treatment for newborn jaundice that can be given at home using devices such as fiberoptic blankets or headbands. These devices shine light on the baby's skin to help the body remove bilirubin. Home treatment may allow babies to stay with their families, continue feeding routines, and avoid a hospital stay. However, safe use requires daily bilirubin blood tests, reliable equipment, and caregivers who can closely follow treatment instructions. Babies with certain risk factors for brain injury from high bilirubin levels should not receive phototherapy at home. Studies suggest home phototherapy can work well for selected low-risk newborns, but some studies found higher hospital readmission rates, and more research is needed to better understand long-term outcomes and which babies benefit most.

What the Studies Show

Newborn jaundice is common because babies break down extra red blood cells after birth, which increases bilirubin levels. Most cases improve on their own, but very high bilirubin levels can harm the brain. Phototherapy uses blue light shined on the skin to help remove bilirubin from the body. In hospitals, stronger light sources are used and babies usually wear eye protection. Home devices typically use lower-intensity light and do not require eye covering.

Several studies found that home phototherapy can lower bilirubin levels in carefully selected newborns. Some studies found similar results between home and hospital treatment, with few serious problems reported. Other studies found that babies treated at home were more likely to be readmitted to the hospital, although bilirubin levels generally improved at similar rates. Researchers noted that many studies were small or had limitations, and larger studies are needed to know whether different home phototherapy approaches improve health. Safe treatment depends on daily follow-up, bilirubin blood testing, proper use of the equipment, and prompt medical care if bilirubin levels continue to rise. Potential harms include delayed treatment if bilirubin levels increase despite home therapy, which may increase the risk of serious complications.

When is Home Phototherapy Clinically Appropriate?

Home phototherapy for neonatal hyperbilirubinemia (newborn jaundice) may be appropriate in these situations:

When is this not Clinically Appropriate?

Home phototherapy is not clinically appropriate when any of the criteria listed above are not met.

Using more than one home phototherapy device at the same time (intensive phototherapy) is also not clinically appropriate. Studies and expert recommendations support intensive phototherapy in hospital settings for babies who need more intensive treatment and closer monitoring. Babies with higher-risk conditions may require stronger treatment and frequent assessment to reduce the risk of complications from rising bilirubin levels.

When treatment is used outside the recommended situations, bilirubin levels may not be monitored closely enough or may continue to rise despite treatment, resulting in complications including brain damage.

(Return to Description)

Coding

The following codes for treatments and procedures applicable to this document are included below for informational purposes. Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member.

When services may be Medically Necessary when criteria are met:

HCPCS

 

E0202

Phototherapy (bilirubin) light with photometer

S9098

Home visit, phototherapy services (e.g., Bili-lite), including equipment rental, nursing services, blood draw, supplies, and other services, per diem

 

 

ICD-10 Diagnosis

 

 

All diagnoses

When services are Not Medically Necessary:
For the procedure codes listed above when criteria are not met or for situations designated in the Clinical Indications section as not medically necessary.

Discussion/General Information

Summary

Neonatal hyperbilirubinemia affects roughly 50% of term and 80% of preterm infants; although usually transient, unchecked rises in total serum bilirubin (TSB) can cause neurotoxicity, particularly in infants under 38 weeks’ gestation or with hemolysis, sepsis, hypoalbuminemia, or recent instability. Hospital phototherapy supplies high-irradiance blue light (≥ 30 µW/cm² per nm at about 475 nm) to maximally exposed skin, whereas home devices deliver lower-intensity fiber-optic light that permits feeding and eliminates the need for eye shielding. The 2022 American Academy of Pediatrics (AAP) guideline and the joint 2017 AAP/American College of Obstetricians and Gynecologists (ACOG) perinatal care guidelines recommend home treatment only when reliable equipment, daily TSB checks, and caregiver adherence are assured, and both advise against home phototherapy for any infant with neurotoxicity risk factors. Retrospective and randomized studies, as well as two recent meta-analyses, show that home phototherapy can achieve bilirubin reductions comparable to inpatient treatment in low-risk near-term neonates, with pooled hospital readmission rates near 3-4%; however, one meta-analysis found significantly higher readmission with home care (risk ratio 4.61), and the certainty of evidence across studies is rated ‘low’ to ‘very low’. Monitoring requirements also constrain home use: transcutaneous bilirubin measurement cannot replace serum TSB during home phototherapy, making daily blood sampling a continuing necessity. Emerging device formats, including wearable LED rompers and multidirectional undersurface phototherapy, are under early investigation.

Discussion

The jaundiced skin and sclera in newborns are the result of accumulation of unconjugated bilirubin. In most infants, unconjugated hyperbilirubinemia reflects a normal transitional phenomenon. However, in some infants, serum bilirubin levels may rise excessively, which can be a cause for concern as unconjugated bilirubin can be neurotoxic. As TSB rises closer to the phototherapy threshold, the potential need for escalation of care or future phototherapy also rises. The AAP guideline for the Management of Hyperbilirubinemia in the Newborn Infant 35 or More Weeks of Gestation (Kemper, 2022) notes that some infants are at greater risk of developing bilirubin neurotoxicity. Those risk factors include gestational age less than 38 weeks; albumin less than 3.0 g/dL; isoimmune hemolytic disease (for instance, positive direct antiglobulin test), glucose-6-phosphate dehydrogenase (G6PD) deficiency, or other hemolytic conditions; sepsis; and significant clinical instability in the previous 24 hours. Therefore, the presence of neonatal jaundice frequently requires diagnostic evaluation and treatment.

In the hospital setting, phototherapy is delivered by exposing the infant to fluorescent light. When this type of light source is used, the infant’s eyes are protected from the lights with a mask. The infant is positioned in an incubator wearing only a diaper, exposing as much of the infant’s skin surface as possible to the light source. For those infants with very high bilirubin levels, intensive phototherapy may be used. This type of phototherapy employs two light sources such as fluorescent and fiber optic light, including light-emitting diode (LED) sources. The 2022 AAP guideline indicates, “Intensive phototherapy requires a narrow-spectrum LED blue light with an irradiance of at least 30 µW/cm2 per nm at a wavelength around 475 nm.”

In the home setting, phototherapy is accomplished by using devices such as fiberoptic blankets or neck rings. This light is directed below the infant’s head and is less intense than fluorescent light; therefore, masking the infant’s eyes is not necessary. The infant can also be fed without interrupting therapy. For home phototherapy to be safe and effective, the caregivers must be compliant with the treatment protocol and daily follow-up appointments must be kept. Additionally, the infant should be alert, eating, and voiding and stooling well. If the serum bilirubin level is rising in spite of home phototherapy, the infant may be treated with intensive phototherapy in the inpatient setting.

Regarding home phototherapy, the 2022 AAP guideline states:

Home phototherapy can be less costly and disruptive to family routines and breastfeeding and may help improve bonding and reduce stress compared with readmission for phototherapy. However, its effectiveness depends on the quality of the home phototherapy device as well as the ability of the family to appropriately use it. Therefore, caution is needed when considering home phototherapy. Furthermore, home phototherapy is not recommended for infants with any hyperbilirubinemia neurotoxicity risk factor.

Home phototherapy should not be used if there is any question about the quality of the home phototherapy device, the ability to have the device delivered to the home rapidly, concerns about the family’s ability to use the device, or concerns about the ability to measure bilirubin concentrations daily. As with inpatient phototherapy, it is an option to start home phototherapy at a lower threshold (eg, 2 mg/dL below the phototherapy threshold) to reduce the readmission risk.

The document also provides guidance on discontinuation of phototherapy. That guidance indicates:

Discontinuing phototherapy is an option when the TSB has decreased by at least 2 mg/dL below the hour-specific threshold at the initiation of phototherapy. A longer period of phototherapy is an option if there are risk factors for rebound hyperbilirubinemia (eg, gestational age <38 weeks, age <48 hours at the start of phototherapy, hemolytic disease).

The AAP/ACOG guidelines for perinatal care (2017) state that home phototherapy is a therapy option and eligible candidates require proper home care follow-up and supervision including obtaining blood samples to measure TSB levels. This is to allow for close monitoring to ensure TSB levels are decreasing, and to ensure swift intervention in the event that levels are not responding to home phototherapy.

In 2020, Chang and Waite published the results of a retrospective cohort study evaluating home phototherapy for neonatal hyperbilirubinemia. A total of 1324 infants born at ≥ 35 weeks gestation met inclusion criteria. The primary endpoint was hospitalization for inpatient phototherapy during or within 24 hours of completion of home phototherapy. The mean initial TSB was 16.9 ± 2.5 mg/dL; the mean duration of treatment was 53 hours (interquartile range [IQR], 44-72 hours; range, 15-280 hours); and the median number of home nursing visits was 4 (IQR, 4-5; range, 3-13). All infants were treated with the BiliBed® (Medela, McHenry, IL) and a total of 414 (31.3%) infants were treated with both the BiliBed and a fiberoptic pad. The mean rate of TSB decline was similar for infants that were treated using BiliBed only versus the BiliBed and fiberoptic pad (0.08 ± 0.06 mg/dL/hour versus 0.09 ± 0.07 mg/dL/hour; p=0.14). A total of 25 infants were admitted to the hospital; 15 were admitted for rising TSB levels and 3/15 caregivers were not compliant with home phototherapy due to “fussiness.” A total of 14/15 infants with rising TSB levels had TSB above the treatment threshold (mean 3.7 ± 2.6 mg/dL above). The remaining 10 admissions were a result of parental request (n=3), other clinical concern (n=6), and power outage (n=1); 5 of these admissions had TSB above the treatment threshold and 5 were below. A second course of treatment was required for 18 infants (1.4%; 95% confidence interval [CI], 0.9-2.1%). Starting home phototherapy at or above the AAP treatment threshold was a risk factor for admission or repeat home therapy. If the infant was less than 96 hours of age at initial treatment, then a longer duration of phototherapy was required. A potential bias was physician selection of families to participate with home phototherapy. The results may not be generalizable due to the equipment used and the large selection of phototherapy options available. In conclusion, this study adds to the growing body of literature demonstrating that home phototherapy is an effective treatment for neonatal hyperbilirubinemia.

In 2020, Chu and colleagues pooled 4 randomized controlled trials (RCTs) (n=259) comparing home- versus hospital-based phototherapy for neonatal hyperbilirubinemia. The meta-analysis yielded a pooled standard mean difference (SMD) of 0.32 for total-serum-bilirubin decline (95% CI -0.22 to 0.86; p=0.04), favoring the home setting, but the 95% CI crosses the null and substantial heterogeneity was present (I²=89%). In sensitivity analysis, removing the Yilmaz and colleagues (2015) study, which contributed heavily to the pooled estimate, attenuated both the effect size and heterogeneity. For treatment duration the pooled SMD was 0.59 (reported 95% CI, 0.28-0.90; p=0.06, I²=90%), suggesting a possible longer course of therapy at home, though again statistical inconsistency (CI vs. p) and heterogeneity limit confidence. Overall, the direction of effect favors home care for bilirubin reduction, but precision is poor, pooled results hinge on one study, and the duration of effect is inconclusive. Authors deem home phototherapy feasible and safe but call for larger RCTs with demonstration of sustained outcomes.

An unblinded RCT performed by Pettersson in 2021 set out to determine safety and efficacy, length of stay, and number of failed treatments in term newborns that were randomized to either home phototherapy or conventional in-hospital phototherapy. The study included 147 participants, of whom 78 were randomized to home phototherapy and 69 were randomized to conventional phototherapy. The secondary outcomes were weight gain during treatment and the number of blood samples taken. The inclusion criteria denoted that the newborns needed to have a gestational age above 36 + 0 weeks, a chronological age of more than 48 hours, and a TSB above 18 mg/dL between 48 and 72 hours of age or a TSB higher than 20.5 mg/dL after 72 hours of age. Additionally, the caregivers of the newborns needed to be capable of performing the therapy and agree to return to the hospital for daily checkups. The device used for home phototherapy was the BiliSoft™ Phototherapy System (GE HealthCare, Chicago, IL) which is a single light-emitting diode fiber optic device. The control group receiving hospital-based phototherapy was treated with either the same BiliSoft unit or overhead devices. Caregivers in the study group were instructed to keep a diary of the duration of phototherapy, where the phototherapy took place, and the times the newborn was fed. The authors noted that no advice was given on nutrition or using formula, so the newborns were fed per the caregivers’ choice. The results showed that there were no statistically significant differences in the duration of treatment, weight change, amount of blood tests, or length of stay between the two groups. No participants required blood exchanges and 4% (n=3) of the participants in the study group were admitted to the hospital. All 3 participants received less than 10 hours of therapy under the lights within the previous 24 hours. There were three protocol violations in which infants received a treatment that they were not randomized to. These 3 participants were analyzed in the groups they were randomized to in accordance with the intention-to-treat principle. There were also 3 participants whose home therapy was discontinued due to the caregivers’ wishes. In the final analysis, 3 participants (2 in the control group and 1 in the study group) were not included because the families decided to stop taking part in the study. One participant in the control group was lost to follow-up. The authors concluded that for otherwise healthy newborns who have hyperbilirubinemia, home phototherapy could be a safe alternative to inpatient phototherapy if daily checkups and around-the-clock telephone support can be provided.

In 2023, Orringer and colleagues conducted a retrospective cohort study (through medical record review) of newborns (n=359) aged 2-8 days with a diagnosis of hyperbilirubinemia (total serum bilirubin of 0.1 to 3.0 mg/dL below inpatient threshold) at their regularly scheduled outpatient newborn visit. The study purpose was to characterize home biliblanket treatment for hyperbilirubinemia. Investigators used Bilitool (an online resource based on the AAP hyperbilirubinemia guidelines) to assess neonatal hyperbilirubinemia risks and inpatient treatment thresholds. The study’s primary outcome was whether use of a biliblanket impacted hospital readmission. Of the 359 newborns, a total of 32 (9%) were readmitted for the treatment of hyperbilirubinemia. A total of 159 (44%) newborns used a home biliblanket. Just 6 (4%) newborns who used a biliblanket at home were readmitted compared to 26 (13%) of those who did not (p=0.002). The odds of being readmitted were significantly lower for newborns treated with a biliblanket (odds ratio [OR], 0.16; 95% CI, 0.06 to 0.44). The study authors concluded, “home biliblanket use was associated with lower odds of hospital readmission for newborn jaundice.” Study limitations included the lack of randomization, retrospective design, and limited sample size.

In 2024, Li and colleagues published results of a meta-analysis of RCTs and cohort studies to characterize the efficacy of home phototherapy compared to inpatient phototherapy for the treatment of hyperbilirubinemia in newborns. Outcome measures included duration of phototherapy, daily reduction of bilirubin levels, hospital readmission, and complications. A total of 9 studies comprised of 998 participants were included (4 RCTs and 5 cohort studies). Home phototherapy was associated with longer duration of therapy (p=0.03). Hospital readmission was significantly higher with home phototherapy (risk ratio [RR], 4.61; 95% CI, 1.43-14.86; p=0.01) whereas daily bilirubin reduction and complications were not significantly different. While the authors conclude, “…current evidence does not strongly support [home phototherapy] efficacy for neonatal hyperbilirubinemia, as high-quality data on long-term outcomes are scarce,” the limitations acknowledge the certainty of the evidence included in this review was “very low.” Furthermore, while readmissions were higher in the newborns receiving home phototherapy, readmissions did not appear to be driven by ineffectiveness of home phototherapy treatment as daily bilirubin reduction and complication rates were not significantly different. Further study is warranted.

Spaan and colleagues (2025b) published a mixed-methods systematic review and meta-analysis evaluating home phototherapy, including comparisons with in-hospital phototherapy. A total of 31 studies representing 5059 neonates (35 weeks' gestation or more, 0 to 28 days), 869 healthcare professionals, and 478 parents were included. The pooled hospital readmission rate was 3.5% (95% CI, 2.2 to 5.3; I²=67%; 17 studies). There were no statistically significant differences in treatment duration (mean difference [MD], 4.9 hours; 95% CI, -8.0 to 17.9) or daily bilirubin reduction (MD, 5.7 µmol/L; 95% CI, -2.6 to 13.9). No severe adverse events were reported across 8 studies (688 home-treated neonates), with no exchange transfusions, acute bilirubin encephalopathy, or kernicterus. The authors concluded that home phototherapy "can be a safe and effective alternative to in-hospital phototherapy... in low-risk (near-)term neonates, although the strength of this recommendation is low"; the certainty of evidence was low to very low.

Pettersson and colleagues (2025) reported a retrospective, population-based implementation study of 492 newborns at 36 weeks' gestation or more who received phototherapy at a single Swedish center (2019 to 2023). Using a single fiberoptic device (BiliSoft), 256 (52%) were treated at least partly at home (180 exclusively), and approximately half were considered suitable for home care. The most common reasons for hospital treatment were hemolytic disease (35%) and the need for multiple phototherapy devices (26%). Only 2 of 256 home-treated infants (0.8%) were readmitted for rising bilirubin (overall readmission, 4.3%). The authors concluded that home phototherapy may be suitable for approximately half of otherwise eligible term and near-term infants with neonatal hyperbilirubinemia, with hemolytic disease and severe hyperbilirubinemia requiring intensive phototherapy as the principal reasons for hospital-based treatment.

Erlandsson Speychal and colleagues (2025) assessed whether transcutaneous bilirubin (TcB) could replace TSB during home phototherapy in a secondary analysis of a randomized trial (141 infants; 856 paired measurements). Before phototherapy, agreement was poor (r=0.06 uncovered, r=0.11 covered; both nonsignificant), with TcB underestimating TSB by more than 50 µmol/L in 78% to 97% of measurements. They concluded that TcB "cannot replace measurement of TSB level before, during, or after home phototherapy", supporting continued reliance on TSB for eligibility and monitoring decisions.

Spaan and colleagues (2025a) described a first-in-human pilot of a wearable LED phototherapy romper in 12 (near-) term neonates without known neurotoxicity risk factors at inclusion compared to 12 matched historical controls (BiliSoft). Phototherapy was discontinued within 48 hours in 10 of 12 (83%) romper-treated neonates versus 11 of 12 (92%) controls, with similar TSB decline and duration; 2 infants (17%) required a switch to conventional phototherapy and were treated successfully. No serious adverse events were reported. The authors concluded that wearable phototherapy "is effective and safe... in the majority of (near-)term neonates," noting the small sample, historical (rather than concurrent) controls, and delivery in a supervised (non-home) setting.

Magee and colleagues (2026) published a randomized pilot trial comparing multidirectional with unidirectional undersurface phototherapy in the home for 17 exclusively breastfed infants (37 weeks or more, 2500 g or more) who developed jaundice after discharge. Treatment time was shorter with multidirectional phototherapy (15.1 ± 6.4 vs. 25.1 ± 11.8 hours; p=0.05), and the bilirubin reduction rate was higher (0.40 ± 0.21 vs. 0.14 ± 0.10 mg/dL/hour; p=0.006); all infants were treated effectively with no readmissions or adverse events. Limitations included the small sample, lack of care-team blinding, and a financial conflict of interest (a senior author holds equity in the device manufacturer).

References

Peer Reviewed Publications:

  1. Chang PW, Waite WM. Evaluation of home phototherapy for neonatal hyperbilirubinemia. J Pediatr. 2020; 220:80-85.
  2. Chu L, Qiao J, Xu C. Home-based phototherapy versus hospital-based phototherapy for treatment of neonatal hyperbilirubinemia: a systematic review and meta-analysis. Clin Pediatr (Phila). 2020; 59(6):588-595.
  3. Erlandsson Speychal F, Pettersson M, Eriksson M, et al. Transcutaneous bilirubin in newborns before, during, and after home phototherapy: results from a secondary analysis of a randomized controlled trial. PLoS One. 2025; 20(3):e0320067.
  4. Li R, Li T, Yan X, et al. Efficacy of home phototherapy versus inpatient phototherapy for neonatal hyperbilirubinemia: a systematic review and meta-analysis. Ital J Pediatr. 2024; 50(1):37.
  5. Magee S, Roberts M, Gilbert GE. Multi-directional phototherapy vs. unidirectional phototherapy from below for severe neonatal jaundice: a randomized pilot trial in home phototherapy. Eur J Pediatr. 2026; 185(6):260.
  6. Moerschel SK, Cianciaruso LB, Tracy LR. A practical approach to neonatal jaundice. Am Fam Physician. 2008; 77(9):1255-1262.
  7. Orringer K, Kileny S, Salada K, et al. Biliblanket utilization for outpatient treatment of newborn jaundice. Clin Pediatr (Phila). 2023; 62(7):725-732.
  8. Pettersson M, Eriksson M, Albinsson E, Ohlin A. Home phototherapy for hyperbilirubinemia in term neonates-an unblinded multicentre randomized controlled trial. Eur J Pediatr. 2021; 180(5):1603-1610.
  9. Pettersson M, Lai C, Ohlin A. How to select the correct patients for home phototherapy of neonatal hyperbilirubinaemia: a retrospective population-based implementation study. Eur J Pediatr. 2025; 184(8):515.
  10. Spaan J, Been JV, Wallé Y, et al. First in-human pilot study of wearable phototherapy for neonatal hyperbilirubinaemia. Eur J Pediatr. 2025a; 184(7):407.
  11. Spaan J, Westenberg LEH, Ista E, et al. Home phototherapy for neonatal hyperbilirubinemia: a mixed methods systematic review and meta-analysis. Pediatr Res. 2025b Jul 26. [Epub ahead of print].
  12. Tan KL. Comparison of the efficacy of fiberoptic and conventional phototherapy for neonatal hyperbilirubinemia. J Pediatr. 1994; 125(4):607-612.
  13. Tan KL. Efficacy of bidirectional fiber-optic phototherapy for neonatal hyperbilirubinemia. Pediatrics. 1997; 99(5):E13.
  14. Yilmaz A, Ozkiraz S, Akcan AB, Canpolat M. Low-cost home-use light-emitting-diode phototherapy as an alternative to conventional methods. J Trop Pediatr. 2015; 61:113-118.

Government Agency, Medical Society, and Other Authoritative Publications:

  1. American Academy of Pediatrics, American College of Obstetricians and Gynecologists. Guidelines for perinatal care. 8th ed. Elk Grove Village (IL): AAP; Washington, DC: American College of Obstetricians and Gynecologists; 2017. Available at: https://publications.aap.org/aapbooks/book/522/Guidelines-for-Perinatal-Care. Accessed on August 14, 2026.
  2. Kemper AR, Newman TB, Slaughter JL, et al. Clinical practice guideline revision: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2022; 150(3):e2022058859.
  3. Kumar P, Chawla D, Deorari A. Light-emitting diode phototherapy for unconjugated hyperbilirubinaemia in neonates. Cochrane Database Syst Rev. 2011;(12):CD007969.
  4. Malwade US, Jardine LA. Home- versus hospital-based phototherapy for the treatment of non-haemolytic jaundice in infants at more than 37 weeks' gestation. Cochrane Database Syst Rev. 2014;(6):CD010212.
  5. Okwundu CI, Okoromah CA, Shah PS. Prophylactic phototherapy for preventing jaundice in preterm or low birth weight infants. Cochrane Database Syst Rev. 2012;(1):CD007966.
Websites for Additional Information
  1. National Institutes of Health. Newborn jaundice. Reviewed January 1, 2025. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/001559.htm. Accessed on August 14, 2026.
Index

BiliBed
BiliBlanket®
Bili-lite™
BiliSoft 2.0 Phototherapy System
BiliSoft Phototherapy System
Hyperbilirubinemia
Neonatal Jaundice
Phototherapy
Total Serum Bilirubin (TSB)

The use of specific product names is illustrative only. It is not intended to be a recommendation of one product over another, and is not intended to represent a complete listing of all products available. 

History

Status

Date

Action

Revised

08/13/2026

Medical Policy & Technology Assessment Committee (MPTAC) review. Revised the American Academy of Pediatrics Clinical Practice Guideline footnote in the Clinical Indications section. Added “Summary for Members and Families” section. Revised Discussion/General Information, References, and Websites for Additional Information sections.

Reviewed

08/07/2025

MPTAC review. Revised Discussion/General Information, References, and Index sections.

Reviewed

08/08/2024

MPTAC review. Revised Discussion/General Information, References, Websites for Additional Information, and Index sections.

Revised

08/10/2023

MPTAC review. Reformatted Clinical Indications section. Revised Clinical Indications to address neurotoxicity risk factors and remove criteria related to environment, follow-up, and eating, etc. Revised link to AAP Clinical Practice Guideline in Clinical Indications. Revised Discussion/General Information, References, Websites for Additional Information, and Index sections.

Reviewed

08/11/2022

MPTAC review. Updated Discussion and Websites for Additional Information sections.

Reviewed

08/12/2021

MPTAC review. Updated Websites for Additional Information section.

Reviewed

08/13/2020

MPTAC review. Updated Discussion/General Information, References, Websites for Additional Information, and Index sections. Reformatted Coding section.

Reviewed

08/22/2019

MPTAC review. Updated Website section.

Revised

09/13/2018

MPTAC review. Updated link to AAP guidelines in MN statement. Updated Discussion/General Information section.

Reviewed

11/02/2017

MPTAC review. The document header wording updated from “Current Effective Date” to “Publish Date.” Updated hyperlink in clinical indications section. Updated References section.

Reviewed

11/03/2016

MPTAC review. Updated References section.

Reviewed

11/05/2015

MPTAC review. Updated Reference section. Removed ICD-9 codes from Coding section.

Reviewed

11/13/2014

MPTAC review.

Reviewed

11/14/2013

MPTAC review. References updated.

Revised

11/08/2012

MPTAC review. Added not medically necessary statement for when medically necessary criteria have not been met. Updated References section.

Reviewed

11/17/2011

MPTAC review. Coding and References updated.

Reviewed

11/18/2010

MPTAC review. References updated.

Reviewed

11/19/2009

MPTAC review. Removed Place of Service/Duration table. Updated Discussion/General Information and References.

Reviewed

11/20/2008

MPTAC review. References updated.

Reviewed

11/29/2007

MPTAC review. Description and references updated.

Reviewed

12/07/2006

MPTAC review.

Revised

12/01/2005

MPTAC review. Revision based on Pre-merger Anthem and Pre-merger WellPoint Harmonization.

Pre-Merger Organizations

Last Review Date

Document Number

Title

Anthem, Inc.

 

 

None

WellPoint Health Networks, Inc.

12/02/2004

 

Home Phototherapy Devices for Neonatal Hyperbilirubinemia

 


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