MedicaidPrior AuthMedium impact
22-1055m Nursing Facility Transition/Diversion Program Promotes Independent Living
Health Net·CA · Family Medicine, Internal Medicine, Geriatrics·Prior Authorization
We identified it
Jun 20, 2026
Summary
New prior authorization requirements established for Nursing Facility Transition/Diversion Program services using billing code T2038 with modifier U4. This program helps members transition from nursing facilities to assisted living settings and requires specific eligibility criteria to be met.
Action Required
Immediately: Billing team must update system to require prior authorization for code T2038 with modifier U4 for Nursing Facility Transition/Diversion services. Verify member eligibility criteria including 60-day nursing facility stay for transitions or nursing facility level of care for diversions. Access Community Supports authorization guides on provider website under Forms & Tools. Claims without proper authorization will be denied.