Hospital Billing Guidance for Donor Breast Milk 

May 22, 2023

On January 1, 2023, MaineCare added coverage for donor breast milk under Section 90, Physician Services and Section 45, Hospital Services, in accordance with Maine P.L. 2021, ch. 708 (L.D. 85), An Act Concerning MaineCare Coverage for Donor Breast Milk.     

Hospitals must bill for donor breast milk delivered in the outpatient setting, on the UB-04 claim form, with revenue code 0220 and CPT code T2101. MaineCare does not provide separate reimbursement for donor breast milk delivered in the inpatient setting, but hospitals must still include revenue code 0220 on the inpatient UB-04 claim form when delivering donor breast milk. Donor breast milk provided under Section 45 does not require prior authorization, but members must meet the criteria below for providers to receive reimbursement.     

MaineCare covers donor breast milk for infants under 12 months when a physician, physician assistant, or advanced practice registered nurse orders the donor breast milk and when infants meet the following criteria:    

1. The infant is medically or physically unable to receive maternal breast milk or participate in breastfeeding, or the infant's mother is medically or physically unable to produce maternal breast milk in quantities sufficient for the infant; and  

2. The infant:  

• Was born at a birth weight of less than 1,500 grams;  

• Has a gastrointestinal anomaly or metabolic or digestive disorder or is recovering from intestinal surgery, and the infant's digestive needs require additional support;  

• Is not appropriately gaining weight or growing;  

• Has formula intolerance and is experiencing weight loss or difficulty feeding;  

• Has low blood sugar;  

• Has congenital heart disease;  

• Has received or will receive an organ transplant; or  

• Has another serious medical condition for which donor breast milk is medically necessary. 

Please contact your Provider Relations Specialist with questions.