MedicaidCoverageMedium impact
Coverage of Human Donor Breast Milk
Illinois Medicaid - HFS·IL · Pediatrics, Family Medicine, General Practice·Provider Notice
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Illinois Medicaid now covers pasteurized donated human breast milk for infants meeting specific medical criteria. Prior approval is required using forms HFS 1305 and HFS 1409 for fee-for-service participants, and billing should use HCPCS code T2101.
Action Required
Immediately: Billing team must add HCPCS code T2101 (Human Breast Milk Processing, Storage and Distribution) to billing system for Illinois Medicaid claims. Prior to billing, obtain prior approval using forms HFS 1305 (Questionnaire for Human Donor Milk) and HFS 1409 (Prior Approval Request form) for fee-for-service participants. For managed care enrollees, verify prior approval requirements with the specific MCO. Claims will be invalid without required prior approval documentation.