Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
CareSourceMedicaid · Prior Auth · Specialty Services · GA · PsychiatryHigh impact

[Georgia] Clarification on Behavioral Health Outpatient Therapy Codes

Act
by Jul 10, 2025
Effective date
Jul 10, 2025
Identified
May 9, 2026

Summary

CareSource Georgia Medicaid clarifies prior authorization requirements for behavioral health outpatient therapy codes. Prior authorization is now required when individual therapy sessions (90837, 90832, 90834) or family therapy sessions (90846, 90847) exceed 24 per member per calendar year. For 2025, sessions on or after July 10, 2025 that exceed the 24-session threshold require prior authorization.

Get alerts when payers change rules like this one

We check CareSource and other payers every day and email you when a change matches your specialty and state.

Get CareSource alertsPolicy Monitoring is free. No card required.

What to do

by Jul 10, 2025 · 8 steps
01Billing team must implement session tracking and prior authorization requirements in billing system for behavioral health therapy codes.
02Configure system to count combined individual therapy sessions (90837, 90832, 90834) per member per calendar year starting January 1, 2025, and flag when combined total reaches 24.
03Configure system to count combined family therapy sessions (90846, 90847) per member per calendar year and flag when combined total reaches 24.
04For any sessions 24+ with date of service July 10, 2025 or later, require prior authorization submission before claim processing.
05For DBHDD providers, ensure family therapy is counted by session (not unit).
06Update claim denial protocols to reject claims for sessions 24+ without prior authorization documentation.
07Train billing staff to obtain prior authorization before scheduling or billing therapy session 25 and beyond.
08Notify providers to request prior authorization when session 24 is reached.
If missed: Failure to obtain prior authorization will result in claim denials.

Codes mentioned

9083790832908349084690847

Original notice

[Georgia] Clarification on Behavioral Health Outpatient Therapy Codes
caresource.com · Always check the source before changing claims.
View original ↗

Related changes

See all CareSource changes →
[Georgia] Prior Authorization Requirement UpdateHighEffective Jul 10, 2025 · Provider Bulletin[Georgia] CareSource Policy and Prior Authorization changesHighEffective Jan 1, 2026 · Medical PolicyBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesGA policy changesPsychiatryCode 90837Code 90832Code 90834Code 90846Code 90847

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account