MedicaidCoverageMedium impact
Supplement 24-10: Human Donor Milk Billing and Guidance in Outpatient Setting
New Mexico Medicaid·NM · Pediatrics, Family Medicine·Claims & Billing
Effective date
Jul 1, 2024
We identified it
Jun 21, 2026
Summary
New Mexico Medicaid now covers Pasteurized Human Donor Milk (PHDM) for high-risk infants up to 12 months old in outpatient settings, effective July 1, 2024. Providers must enroll as DME suppliers with specific specialty codes and meet HMBANA certification requirements to bill for these services.
Action Required
By October 7, 2024: Providers serving high-risk infants must enroll with New Mexico Medicaid as Provider Type 414 with Specialty Code 208 if billing for human donor milk. Submit required documentation including HMBANA certification, business license, liability insurance, and tax forms. Update billing systems with new procedure codes T2101, E0602-E0603, A4281-A4287, and A9999 with modifier U1. Use taxonomy code 32BP3500X for claims. Document infant eligibility criteria including birth weight under 2500 grams and qualifying medical conditions in medical records.