MedicaidAdministrativeMedium impact
[Georgia] Policy Updates September 2025
CareSource·GA · Orthopedics, PM&R (Physical Medicine & Rehab), General Surgery·Medical Policy
Effective date
Oct 1, 2025
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid released four policy updates effective October 1–November 1, 2025: revisions to Continuity of Care (administrative), a new policy on Cosmetic and Reconstructive Services (reimbursement), and revisions to Myoelectric Lower Extremity Prosthetic Technology and Noninvasive Home Mechanical Ventilation (medical policies). This notification consolidates monthly policy changes; billing teams must review each policy individually via the CareSource website to identify specific code, coverage, or documentation impacts.
Action Required
By September 30, 2025: Billing team must access each of the four revised/new policies on CareSource.com (Providers > Tools & Resources > Provider Policies, select Georgia Medicaid) and review full policy text for: (1) CPT/HCPCS codes affected; (2) coverage changes or exclusions; (3) prior authorization requirements; (4) documentation mandates. Compare revised policies against archived versions to identify specific billing rule changes. Update billing software, encounter forms, and internal workflows based on findings from each policy. Document changes in compliance log. Note: This notification does not provide specific codes or requirements—full policies must be reviewed individually to determine operational impact and claim submission changes. Failure to implement policy-specific requirements by effective dates (Oct 1 and Nov 1, 2025) may result in claim denials.