MedicaidCoverageMedium impact
Exempt Infant Formula Coverage
Nebraska Medicaid·NE · Pediatrics, Family Medicine·Medical Policy
Effective date
May 19, 2026
We identified it
Jun 21, 2026
Summary
Nebraska Medicaid now covers prescribed 'exempt' infant formula through DME billing using HCPCS codes B4100-B4162. Medicaid is the primary payer and beneficiaries must exhaust their Medicaid monthly limit before receiving these formulas through WIC benefits.
Action Required
Immediately: Billing team must update system to bill exempt infant formula using appropriate HCPCS codes B4100-B4162 through DME fee schedule for Nebraska Medicaid patients. Providers must ensure formula is prescribed by physician and medically necessary. Verify patient has exhausted Medicaid monthly limit before WIC coverage applies.