MedicaidAdministrativeHigh impact
[Georgia] Policy Updates July 2025
CareSource·GA · Physical Therapy, Occupational Therapy, Speech Therapy +3 more·Medical Policy
Effective date
Sep 1, 2025
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid is releasing 8 policy updates effective September 1, 2025, including 3 new policies and 5 revised policies covering emergency services, hospital facility charges, genetic testing, medical documentation standards, billing modifiers, therapy services, nerve stimulators, and urinalysis/E&M reimbursement. Billing teams must review each policy to identify specific workflow and coding changes required for compliance.
Action Required
By August 31, 2025: Billing team must access and review all 8 policy updates on CareSource.com (Providers > Tools & Resources > Provider Policies > Georgia Medicaid). For each policy, identify specific billing code changes, prior authorization requirements, and documentation updates. Key actions: (1) Facility Charges for Hospital-Based Outpatient Clinics (PY-1619, NEW) - determine new facility charge billing methodology and update billing software; (2) Modifiers (PY-1353, REVISED) - identify modifier changes and update encoder software; (3) Urinalysis and Evaluation and Management Services (PY-1605, NEW) - establish new reimbursement guidelines and update fee schedules; (4) Outpatient PT/OT/SLP (AD-0986, REVISED) - review prior authorization or documentation changes; (5) Peripheral Nerve Stimulators (MM-1429, REVISED) - update medical necessity requirements; (6) Emergency Services (AD-1064, REVISED) and Medical Record Documentation Standards (AD-0755, REVISED) - implement new documentation standards in provider encounter templates. Coordinate with providers, IT, and billing coders. Failure to comply by effective date may result in claim denials or payment delays.