MedicaidAdministrativeMedium impact
[Georgia] Policy Updates (1/3) June 2025
CareSource·GA · Pain Management, Gastroenterology, Critical Care +2 more·Medical Policy
Effective date
Aug 1, 2025
We identified it
May 9, 2026
Summary
CareSource Georgia Medicaid is releasing seven policy updates effective August 1, 2025, including revisions to epidural steroid injections, experimental/investigational services, inhaled nitric oxide, non-emergency facility transfers, and peroral endoscopic myotomy, plus a new policy on laboratory testing in office settings and interest payments. The billing team must review each policy individually to identify specific coverage, prior authorization, and coding changes for Georgia Medicaid claims.
Action Required
By July 15, 2025: Billing team must access each of the seven policy updates on CareSource.com (Providers > Tools & Resources > Provider Policies > Georgia Medicaid) and document: (1) which procedures require new/revised prior authorization, (2) coverage changes or exclusions, and (3) any billing code updates. Create internal alert for providers on affected services. Specifically review Laboratory Testing in Office Setting (PY-1462) as it is a NEW policy. Update billing system rules and encounter forms by July 31, 2025 to ensure compliance on August 1 effective date. Failure to implement prior authorization requirements will result in claim denials.