Agencies
Services
Provider Notice issued 11/03/2025
Coverage of Human Donor Breast Milk and Human Milk Fortifiers in the Hospital Inpatient Setting
| To: |
Participating Hospitals: Chief Executive Officers; Chief Financial Officers; and Patient Accounts Managers |
| Date | November 3, 2025 |
| Re: |
Coverage of Human Donor Breast Milk and Human Milk Fortifiers in the Hospital Inpatient Setting |
This notice provides information for hospitals regarding coverage of human donor breast milk and human milk fortifiers for inpatient use, according to Public Act 101-0511. The policy applies to both Medicaid fee-for-service (FFS) and managed care organization (MCO) plans.
Inpatient Billing Guidance for Pasteurized Donated Human Breast Milk and Human-Derived Human Milk Fortifiers
Prior approval is not required for human milk and human-derived milk fortifiers for inpatient use.
Institutional Claims
Human milk and human milk fortifiers prescribed and administered during inpatient stays must be billed under HCPCS code T2101 – Human Breast Milk Processing, Storage and Distribution.
Human milk and human milk fortifiers prescribed and administered during inpatient stays may be billed using revenue codes 0250 or 0636 with J3590 – Unclassified Biologics, dependent upon providers’ contracts.
Questions regarding this notice may be directed to the Bureau of Professional and Ancillary Services at 877-782-5565, or the applicable MCO.
Laura Phelan, Administrator
Division of Medical Programs