MedicaidCoverageHigh impact
[Georgia] Evolent Policy Updates January 2025
CareSource·GA · Radiology, Neurology, Cardiology +4 more·Medical Policy
Effective date
Mar 1, 2025
We identified it
May 9, 2026
Summary
CareSource has updated 56 Evolent Healthcare Advanced Radiology clinical guidelines for Georgia Medicaid members, effective March 1, 2025. These policy updates affect imaging procedures across all body systems including brain, spine, chest, abdomen, pelvis, and extremities. Billing teams must review updated guidelines on the Evolent Healthcare website and ensure prior authorization processes align with any new medical necessity requirements.
Action Required
Before March 1, 2025: Billing team and providers must access and review all 56 updated Evolent Clinical Guidelines at https://www1.radmd.com/ to identify any changes to coverage criteria, medical necessity requirements, or prior authorization triggers for advanced radiology services (CT, MRI, CTA, MRA, PET scans). Update internal billing policies and prior authorization workflows to reflect new guidelines. Radiology ordering providers should be notified of guideline changes. Contact CareSource if clarification is needed on specific guideline changes. Failure to comply with updated medical necessity criteria may result in claim denials for Georgia Medicaid CareSource members.