MedicaidBilling CodesMedium impact
[Georgia] Prothesis and Orthosis Claims Editing Logic
CareSource·GA · Orthopedics, Physical Therapy, PM&R (Physical Medicine & Rehab)·Provider Bulletin
Effective date
Jul 20, 2025
We identified it
May 9, 2026
Summary
Effective July 20, 2025, CareSource Georgia Medicaid is implementing new claims editing logic requiring prosthetics and orthotics that can be billed bilaterally to include anatomic modifiers (LT for left, RT for right). Claims processed without appropriate modifiers may be subject to editing or denial.
Action Required
By July 20, 2025: Billing team must update all prosthetics and orthotics claims to include anatomic modifiers LT (left) or RT (right) for bilateral items in the billing system. Audit current claim templates and encounter forms to ensure providers consistently apply these modifiers. Communicate this requirement to all clinical staff and providers who prescribe or bill prosthetics/orthotics. Train billing staff on correct modifier application. Claims submitted without appropriate anatomic modifiers may be denied or edited by CareSource.