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GUIDANCE ON PASTEURIZED DONOR HUMAN BREAST MILK: BILLABLE WITH HCPCS CODE T2101


Medi-cal guidance for donor human milk




Human Milk Bank

Effective for dates of service on or after December 1, 2022, Medi-Cal covers medically necessary pasteurized donor human milk (PDHM) milk when obtained from a licensed and approved facility. There are two Human Milk banks in California:


San Jose

Mothers’ Milk Bank

1887 Monterey Road, Suite 110 San Jose, CA 95112

Phone: 1-408-998-4550


San Diego

University of California Health Milk Bank

3636 Gateway Center Ave, Suite 102 San Diego, CA 92102

Phone: 1-858-249-6455 (MILK)


Centers for Disease Control and Prevention (CDC) has Guidelines for Proper Storage and Preparation of Breast Milk and Human Milk Storage Guidelines on the Breastfeeding Guidelines & Recommendations page on the CDC website.


Billing Code

HCPCS code T2101 (human breast milk processing, storage and distribution only), to be billed per ounce.


Criteria

Medi-Cal providers can arrange for the provision of PHDM for newborns in at least one of following situations:


  • Infant has documented birthweight of less than 1500 g (3.3 lbs)

  • A congenital or acquired condition places the infant at risk for necrotizing enterocolitis (NEC) and/or infection

  • Infant has a qualifying condition determined by the neonatologist or pediatrician

  • Mother has a condition making their own milk insufficient in quantity or medically unsafe (think of the moms who are not producing enough so they give up)

  • Mother’s milk must be contraindicated, unavailable (due to medical or psychological condition), or available but lacking in quantity or quality to meet the infant’s needs

According to the American Academy of Pediatrics, human milk provides health benefits for all newborn infants but is of particular importance for high-risk infants, especially those born with very low birth weight (less than 1500 g).


Donor human milk also can be beneficial to supplement the mother’s own milk as necessary. Recent studies support health benefits for its use in infants with birthweight less than 1500 g., especially in decreasing rates of NEC.


This guidance was created by BLACK Wellness & Prosperity Center

info@black-enterprises.com

www.Blackwpc.org

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