MedicaidPrior AuthHigh impact
[Georgia] CareSource Policy and Prior Authorization changes
CareSource·GA · Psychiatry, Family Medicine, General Practice +2 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
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.
Action Required
By December 15, 2025: Billing 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). Configure 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. Update provider encounter forms and internal workflows to notify providers of session limits. Training required for billing and authorization staff. Failure to implement will result in claim denials and revenue loss.