MedicaidBilling CodesHigh impact
[Georgia] EPSDT Billing Update
CareSource·GA · Pediatrics, Family Medicine, General Practice·Claims & Billing
Effective date
Aug 20, 2025
We identified it
May 9, 2026
Summary
Effective August 20, 2025, CareSource Georgia Medicaid will implement new claims editing logic requiring EPSDT preventive health visit codes (CPT 99381-99385, 99391-99395) to be billed with modifier EP, and modifier HA when identifying catch-up screenings. Billing teams must update their systems to append these modifiers to EPSDT claims or face potential denials.
Action Required
By August 20, 2025: Billing team must update billing software to automatically append modifier EP to all EPSDT preventive health visit claims (CPT 99381-99385, 99391-99395) for Georgia Medicaid members. For catch-up screenings, ensure modifier HA is added in addition to EP. Update encounter forms and provider templates to reflect modifier requirements. Train billing and clinical staff on correct coding. Verify system changes in test environment before go-live date. Failure to apply required modifiers will result in claim denials or rejections by CareSource.