MedicaidPrior AuthHigh impact
[Georgia] Prior Authorization Requirement Update
CareSource·GA · Genetics, Pathology, Cardiothoracic Surgery +6 more·Provider Bulletin
Effective date
Apr 1, 2026
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid is implementing new prior authorization requirements effective April 1, 2026, for 57 specific billing codes across multiple service categories including genetic testing, durable medical equipment, orthotic/prosthetic devices, and surgical procedures. All non-participating providers and inpatient services already require prior auth; this update expands requirements to include these specific codes for all providers.
Action Required
By March 31, 2026: Billing team must update all billing system workflows to require prior authorization for the 57 specified codes in Addendum A before submitting claims to CareSource Georgia Medicaid. Update claim submission templates, encounter forms, and provider alerts to flag these codes for prior auth initiation. Inform all providers that claims for these codes submitted without prior authorization will be denied. Contact CareSource Provider Services at 1-855-202-1058 (Mon-Fri, 7 a.m.-7 p.m. ET) with any implementation questions.