Effective January 1, 2019, the Oregon Health Authority (OHA) will cover human donor breast milk (HCPCS T2101) for infants up to 6 months of age (adjusted for gestational age) who meet all the following criteria:
- Has low birth weight (<1500g) or severe underlying gastrointestinal disease;
- Continued human donor milk through neonatal hospital discharge for a clear medical indication;
- Has a persistent outpatient medical need for human donor milk due to ongoing severe concerns with persistent diarrhea or malabsorption, with improvement on breast milk compared to formula; and
- The mother’s breast milk is not available, appropriate or sufficient to meet the infant’s needs, despite lactation support for the mother.
Fee-for-service coverage will work as follows:
- OHA has enrolled Northwest Mother’s Milk Bank as an Oregon Health Plan provider (Provider Type 36 – DME/Medical Supply Dealer and Specialty 320 –Donor Milk Bank).
- Northwest Mother’s Milk will bill OHA for donor milk services using HCPCS T2101 (Human breast milk processing, storage and distribution only).
Why is this happening?
The January 1, 2019 Prioritized List of Health Services includes human-donated breast milk on lines 16, 34, 88, and 101 for infants up to 6 months of age (adjusted for gestational age).
What should you do?
To learn more about this benefit, review the provider guidelines on the Home Enteral/Parenteral and IV (EPIV) Services page. We hope this information helps as you implement this benefit in your own organizations.