In support of Massachusetts state legislative guidance pertaining to maternal health, Point32Health will now cover medically necessary inpatient donor human milk and donor human milk-derived products for Massachusetts fully insured Harvard Pilgrim Health Care Commercial and Tufts Health Plan Commercial plans, Tufts Health Direct, Tufts Health One Care, and Tufts Health Together, effective for dates of service on or after Nov. 21, 2024.
We’re pleased to introduce this coverage as a new offering for our member community; it was not included as a member benefit in the past and will now be available to eligible members when the following criteria are met:
- The infant is undergoing treatment in an inpatient setting for a congenital or acquired condition that places the infant at a high risk for development of necrotizing enterocolitis or a congenital or acquired condition that may benefit from the use of such human breast milk as determined by the department of public health
- The milk is obtained from a human milk bank that meets quality guidelines established by the department of public health
- A licensed medical practitioner has issued a written order for the provision of such human breast milk or donor human milk-derived products for the covered infant; and
- The covered infant is under the age of 6 months
- Medically or physically unable to receive maternal breast milk or participate in breastfeeding or whose mother is medically or physically unable, despite receiving lactation support, to produce maternal breast milk in sufficient quantities or caloric density
Claims for donor human milk should be billed on a UB-04 facility claim form using revenue code 0220, and may not be separately reimbursed.
For more information, please refer to our Harvard Pilgrim Commercial Newborn Care and Neonatal Intensive Care Payment Policy, as well as our Tufts Health Plan Commercial and Tufts Health Public Plans Newborn Payment Policies, which we’ve updated to reflect this coverage and billing guidance.