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CareSourceMedicare Advantage · Billing Codes · Claims & Billing · GA · Orthopedics, General Practice, Family Medicine +5 moreHigh impact

[Georgia] Claim Edits for Durable Medical Equipment

Act
by Jan 17, 2026
Effective date
Jan 17, 2026
Identified
May 9, 2026

Summary

CareSource is implementing new claim edits for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) effective January 17, 2026, requiring correct use of modifiers (rental, anatomical, functional, surgical dressings, and other) to prevent claim denials. The policy also establishes a limitation of one breast pump per delivery (240 days/eight months) and applies CMS payment policies across multiple DMEPOS categories.

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What to do

by Jan 17, 2026 · 7 steps
01Billing team must audit and update all DMEPOS billing processes to ensure correct modifier usage, including rental modifiers (RR), anatomical modifiers (LT, RT), functional modifiers (K0-K4), surgical dressing modifiers (A1-A9, GY), and other required modifiers (KF, KX, GA, GZ).
02Update billing software validation rules to enforce proper modifier combinations per CMS guidelines and state requirements.
03Train billing staff on modifier requirements for all affected DMEPOS categories (wheelchairs, hospital beds, oxygen equipment, respiratory assist devices, orthosis, orthopedic footwear, urological supplies, surgical dressings, and capped rentals).
04Implement system edit to limit breast pump codes E0602, E0603, E0604 to one per delivery per 240-day period across all providers.
05Test claims processing before the effective date.
06Failure to apply correct modifiers will result in claim denials.
07Contact CareSource Provider Services with questions: D-SNP (1-833-230-2176), Marketplace (1-833-230-2101), or Medicaid (1-855-202-1058).

Codes mentioned

E0602E0603E0604

Original notice

[Georgia] Claim Edits for Durable Medical Equipment
caresource.com · Always check the source before changing claims.
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Related changes

See all CareSource changes →
[Ohio] Claim Edits for Durable Medical EquipmentHighEffective Jan 15, 2026 · Claims & Billing[Indiana] Claim Edits for Durable Medical EquipmentHighEffective Jun 10, 2026 · Claims & BillingBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesGA policy changesOrthopedicsGeneral PracticeFamily MedicineInternal MedicineGeriatricsPulmonologyWound CareUrologyCode E0602Code E0603Code E0604

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