Medicare AdvantageBilling CodesHigh impact
[Georgia] Claims Editing - Add-On Codes, E/M and Special Services
CareSource·GA·Provider Bulletin
Effective date
Jan 20, 2026
We identified it
May 9, 2026
Summary
CareSource is implementing enhanced claims editing effective January 20, 2026 for Georgia D-SNP, Marketplace, and Medicaid plans. Key changes include: add-on codes will be denied if the primary code is absent or denied, only one E/M code per date of service per provider group/specialty is allowed (with modifier exceptions), and codes 99050/99051 are restricted to office settings only.
Action Required
By January 20, 2026: Billing team must update claims editing logic in billing software to enforce three new rules: (1) deny add-on codes when primary code is absent or denied; (2) reject multiple E/M codes billed on the same date of service for the same provider group and specialty unless appropriate modifiers are used; (3) deny codes 99050 and 99051 when billed outside office settings. Providers must be notified of these changes and reminded to verify primary code submission before add-on codes and to use modifiers correctly for multi-E/M scenarios. Failure to comply will result in claim denials. Contact CareSource Provider Services with questions: D-SNP (1-833-230-2176), Marketplace (1-833-230-2101), or Medicaid (1-855-202-1058).