Products & Programs Long-Term Services & SupportsMedicaidJune 16, 2023

Community-Based Adult Services facility claims reference sheet

The purpose of this bulletin is to provide guidance on billing for Community-Based Adult Services (CBAS) facility claims. To ensure receipt of clean claims and prevent delays in payments, Anthem Blue Cross (Anthem) is providing some helpful information for submission of claims.

Billing codes

The following billing codes are used for CBAS services:

HCPCS code

Description

H2000

Comprehensive multidisciplinary evaluation

S5102

Day care services, adult; per diem

T1023

Screening to determine the appropriateness of consideration 

of an individual for participation in a specified program, project, or treatment protocol, per encounter

 Proper billing procedure utilizing the UB-04:

  • Enter O/P MEDI-CAL in the Payer field.
  • Enter facility type code 89 (special facility – other) as the first two digits in the Type of Bill field (Box 4). The third digit in the Type of Bill field is a frequency code. For original CBAS claims, the frequency code is 1.
  • Enter the type of bill code as 891 for original claims. 
  • Enter frequency code of 1.
  • Enter the appropriate service code in the HCPCS/Rates field. Refer to CBAS Codes and Rates in the Community-Based Adult Services (CBAS): Billing Codes and Reimbursement Rates section of this manual.
  • Enter revenue code 001 to reflect the total charges.
  • Enter 30 in discharge status*. *Do not combine a frequency code of 1 or 4 (still a patient/returning outpatient) with a discharge state of 30 (still a patient/returning outpatient).

Member ID

Please ensure that the member ID listed on the UB-04 matches the member ID on the approved authorization for services:

  • Anthem members enrolled in Medi-Cal Managed Care (Medi-Cal):
    • Use Medi-Cal ID:
      • For example, 12345678A
  • Anthem Medi-Blue Full Dual Advantage members:
    • Use members unique ID:
      • For example, MNL123W12345: 
        • Can be found by:
          • Member insurance card
          • EAE (Exclusively Aligned Enrollment) DSNP (Anthem MediBlue Full Dual Advantage) Customer service 833-707-3129
          • https://bit.ly/3BL4ToP

Questions may be directed to Jamie Nepomuceno at Jamie.Nepomuceno@anthem.com.

Customer care centers:

  • Medi-Cal Managed Care (outside L.A. County): 800-407-4627
  • Medi-Cal Managed Care (inside L.A. County): 888-285-7801
  • CA EAE DSNP (Dual Special Needs Plan) Plan: 833-707-3129

CABC-CD-026030-23