MedicaidBilling CodesMedium impact
22-1028m Housing Options for Members Through Community Transition Services/Nursing Facility Transition Services to a Home
Health Net·CA · Family Medicine, Internal Medicine, Geriatrics·Prior Authorization
We identified it
Jun 20, 2026
Summary
CalViva Health has introduced a new Community Transition Service to help Medi-Cal members transition from nursing facilities to home settings. Billing teams should use service code T2038 U4 for these transition services, which cover non-recurring setup expenses for eligible members who have lived 60+ days in a nursing facility and meet specific eligibility criteria.
Action Required
Immediately: Add service code T2038 U4 to billing system for Community Transition Services/Nursing Facility Transition to Home services. Update encounter forms and train staff on eligibility requirements: members must have 60+ days nursing facility stay, receive medically necessary nursing facility level of care, and be able to reside safely in community. Use Community Supports authorization guides available at CalAIM Resources for Providers to verify member eligibility before billing.