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CareSourceMedicaid · Prior Auth · Provider Bulletin · GA · Physical Therapy, Occupational Therapy, Wound Care +3 moreHigh impact

[Georgia] Prior Authorization Requirement Update

Act
by Jul 10, 2025
Effective date
Jul 10, 2025
Identified
Jun 13, 2026

Summary

CareSource Georgia Medicaid is adding prior authorization requirements for skin substitutes, outpatient therapy codes, new Q1 2025 codes, and other outpatient services effective July 10, 2025. This affects a wide range of commonly used therapy and treatment codes that will require pre-approval before services can be rendered.

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What to do

by Jul 10, 2025 · 5 steps
01Billing team must update prior authorization requirements in billing system for all listed codes.
02Front desk staff must obtain prior authorization before scheduling services using these codes for CareSource Georgia Medicaid patients.
03Update encounter forms and EMR alerts to flag these codes.
04Note special requirement for therapy codes 90832, 90834, 90837, 90846, 90847 - prior auth needed when combined individual and family sessions exceed 24 outpatient visits.
05Services rendered without prior authorization will be denied.

Codes mentioned

Q4104Q4124Q4130Q4132Q4190Q42629250792508925269260997010970129701497016970189702297024970269702897032970339703497035970369703997110971129711397116971249714097150975309753397535977509775597760977619776397799H0036H0039H2011H20159083790832908349084690847E1823E1826E1827E182864467644686446992920929219292492925C1605

Original notice

[Georgia] Prior Authorization Requirement Update
caresource.com · Always check the source before changing claims.
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Related changes

See all CareSource changes →
[Georgia] CareSource Policy and Prior Authorization changesHighEffective Jan 1, 2026 · Medical Policy[Georgia] Clarification on Behavioral Health Outpatient Therapy CodesHighEffective Jul 10, 2025 · Specialty Services[Ohio] Behavioral Health Service Frequency GuidelinesHighEffective Jul 1, 2026 · Specialty Services[Ohio] Community Behavioral Health BillingHighEffective Sep 4, 2025 · Claims & BillingBrowse every CareSource change in the policy list

Related policy hubs

CareSource policiesGA policy changesPhysical TherapyOccupational TherapyWound CarePain ManagementCardiologyPsychiatryCode Q4104Code Q4124Code Q4130Code Q4132Code Q4190Code Q4262Code 92507Code 92508Code 92526Code 92609Code 97010Code 97012Code 97014Code 97016Code 97018Code 97022Code 97024Code 97026Code 97028Code 97032Code 97033Code 97034Code 97035Code 97036Code 97039Code 97110Code 97112Code 97113Code 97116Code 97124Code 97140Code 97150Code 97530Code 97533Code 97535Code 97750Code 97755Code 97760Code 97761Code 97763Code 97799Code H0036Code H0039Code H2011Code H2015Code 90837Code 90832Code 90834Code 90846Code 90847Code E1823Code E1826Code E1827Code E1828Code 64467Code 64468Code 64469Code 92920Code 92921Code 92924Code 92925Code C1605

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[Georgia] Prior Auth Requirement - Medicaid (Jul 2025)