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[Georgia] CareSource Policy and Prior Authorization changes
Act
by Dec 15, 2025
Effective date
Jan 1, 2026
Identified
May 9, 2026
Summary
CareSource Georgia Medicaid is implementing updated prior authorization requirements and service frequency limits for behavioral health codes effective January 1, 2026. Session limits reset annually, and claims exceeding limits without prior authorization will be denied. Non-participating providers now require prior authorization at the first session.
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What to do
by Dec 15, 2025 · 4 steps
01Billing team must update Georgia Medicaid billing system to enforce new session limits and prior authorization triggers for all behavioral health codes (90791, 90792, 90832, 90834, 90837, H0004, H0015, H0031, H0032, H0036, H0039, H2014, H2015, H2017, H2022, S9480, T1016, 90846, 90847).
02Configure system to: (1) reset all session counters on January 1 annually; (2) automatically require prior authorization once session limits are met (24 sessions for psychotherapy codes, 3 encounters for psychiatric evaluations, 16 units for H0031/H0032, 32 units for H2014, 52 units for H2017); (3) require prior authorization for all non-participating providers at first session; (4) deny claims exceeding limits without prior authorization documentation.
03Update provider encounter forms and internal workflows to notify providers of session limits.
04Training required for billing and authorization staff.
If missed: Failure to implement will result in claim denials and revenue loss.
Codes mentioned
9079190792908329083490837H0004H0015H0031H0032H0036H0039H2014H2015H2017H2022S9480T10169084690847
Original notice
[Georgia] CareSource Policy and Prior Authorization changes
caresource.com · Always check the source before changing claims.
Related changes
See all CareSource changes →[Georgia] Prior Authorization Requirement UpdateHighEffective Jul 10, 2025 · Provider Bulletin[Georgia] Clarification on Behavioral Health Outpatient Therapy CodesHighEffective Jul 10, 2025 · Specialty Services[Ohio] Behavioral Health Service Frequency GuidelinesHighEffective Jul 1, 2026 · Specialty Services[Ohio] Community Behavioral Health BillingHighEffective Sep 4, 2025 · Claims & BillingBrowse every CareSource change in the policy list