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3.5.6 Donor Human Milk
3.5.6.1 Services/Benefits and Limitations
Donor human milk is a benefit of CCP for eligible THSteps clients who are birth through 11 months of age meeting all of the following criteria:
• The requesting physician has documented medical necessity and appropriateness.
•The parent or guardian has signed and dated an informed consent form indicating that the risks and benefits of using banked donor human milk have been discussed with them.
•The donor human milk bank adheres to quality guidelines consistent with the Human Milk Bank Association of North America or such other standards as may be adopted by HHSC.
Additional donor human milk benefits beyond the limitations listed above may be available to clients who are birth through 20 years of age with documentation of medical necessity.
Procedure code B9998 must be used when requesting or billing for human donor milk.
Donor human milk is reimbursed at a maximum fee determined by HHSC or manual pricing.
Donor human milk is only reimbursed to a Texas Medicaid enrolled donor milk bank and only for children who are in the home setting.
The physician must address the benefits and risks of using donor human milk, such as HIV, freshness, effects of pasteurization, nutrients, and growth factors to the parent. The physician also must address donor screening, pasteurization, milk storage, and transport of the donor milk. The physician may obtain this information from the donor milk bank.
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