MedicaidAdministrativeMedium impact
[Georgia] Policy Updates (3/3) June 2025
CareSource·GA · Gastroenterology, General Surgery, Plastic Surgery +2 more·Medical Policy
Effective date
Aug 1, 2025
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid released a consolidated notification of six policy updates effective August 1, 2025, spanning medical, reimbursement, and administrative policies. Key changes include revisions to Breast Reconstruction Surgery (MM-0732), Facet Joint Interventions (MM-0974), and new reimbursement guidance for Diagnostic Colonoscopy/Sigmoidoscopy (PY-1594). The billing team must review each linked policy to identify specific billing code impacts and prior authorization requirement changes.
Action Required
By July 15, 2025: Billing team must access each policy via CareSource.com > Providers > Tools & Resources > Provider Policies, select Georgia Medicaid, and review the full text for the following policies: MM-0732 (Breast Reconstruction Surgery), PY-1594 (Diagnostic Colonoscopy/Sigmoidoscopy), MM-0974 (Facet Joint Interventions), AD-0902 (Policy Development Process), and AD-1437 (Provider Prepayment Review). Document any changes to billing codes, prior authorization requirements, or reimbursement rates. Update billing software, encounter forms, and staff training materials accordingly. Failure to comply by August 1, 2025 may result in claim denials or payment delays for affected services.