Thank you for your interest in pursuing donor milk coverage for your child.
Donor milk is billable under Medi-Cal with CPT code T2101 and as of 1/1/2025,
AB3059 defines medically necessary donor milk as an essential health benefit
under commercial insurance plans, establishing coverage parity with Medi-Cal
plans.

Please note that if baby does not have a medical need for donor milk, it
is unlikely the insurance would cover it as a nutrition. That being said, the
first step is to call in to see what your plan's donor milk coverage policies
are.

An indication for medical need includes but is not limited to:

1. Very low birth weight (<1500g) or premature (<32 weeks
   gestation)
2. Gastrointestinal anomaly, metabolic/digestive disorder, or recovery from intestinal surgery when digestive needs require additional support
3. Failure to thrive
4. Severe formula intolerance with documented feeding difficulty/weight loss or medical contraindications to using formula
5. Congenital heart disease, pre or post organ transplant
6. Other serious health conditions when the use of banked donor human milk
   is medically necessary and supports the treatment and recovery of the infant

Donor milk coverage through commercial insurance is relatively new. The processing times might take longer than usual. Another option to consider is donor milk reimbursement. Contact your insurance to learn if this may be an option for your family.