MedicaidAdministrativeMedium impact
[Georgia] Policy Updates December 2025
CareSource·GA · Dentistry, Audiology, Physical Therapy +4 more·Medical Policy
Effective date
Feb 1, 2026
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid released 8 policy updates effective February 1, 2026, including 1 new policy (Multiple Procedure Payment Reduction for Therapies PY-1428) and 7 revised policies. Changes affect dental services reimbursement, cerumen removal administration, medical necessity determinations, pharmacogenomics testing, safety beds, sentinel events, and special needs car seats. Billing teams must review each policy individually on CareSource.com to identify specific code and workflow impacts.
Action Required
By January 24, 2026: Billing team must access CareSource.com > Providers > Tools & Resources > Provider Policies, select Georgia Medicaid plan, and review all 8 policy updates (particularly new policy PY-1428 and revised policies PY-0847, AD-1259, AD-0038, MM-1712, MM-1456, AD-1163, MM-1443). For each policy, identify specific CPT/HCPCS codes affected and document changes to billing rules, prior authorization requirements, and documentation standards in the billing system. Update encounter templates and provider guidance as needed. Verify therapy procedure bundling rules under PY-1428 before February 1, 2026 to prevent claim denials. Assign policy review ownership (e.g., compliance, billing manager) and confirm all staff are trained on changes before the effective date.