MedicaidCoverageMedium impact
Acute Inpatient Hospital Bulletin 205: MassHealth Coverage of Donor Human Milk and Human-Milk-Derived Products
MassHealth·MA · Pediatrics, Critical Care·Medical Policy
Effective date
Oct 14, 2025
We identified it
Jun 18, 2026
Summary
MassHealth now covers donor human milk and human-milk-derived products for infants under 6 months in inpatient settings who meet specific medical criteria. Hospitals must bill using revenue code 220 for these products.
Action Required
By October 14, 2025: Billing team must update hospital billing systems to use revenue code 220 when submitting claims for donor human milk and human-milk-derived products to MassHealth. Ensure documentation includes written orders from licensed practitioners and verification that infants meet all eligibility criteria (under 6 months, inpatient treatment, medical necessity conditions). Claims without proper revenue code will not be processed correctly.