MedicaidPrior AuthHigh impact
[Georgia] Prior Authorization Requirement Update
CareSource·GA · Orthopedics, Cardiology, Neurosurgery +6 more·Provider Bulletin
Effective date
Aug 1, 2026
We identified it
Jun 18, 2026
Summary
CareSource Georgia Medicaid is requiring prior authorization for 90+ new codes across multiple categories including durable medical equipment, hearing services, inpatient facility services, and outpatient diagnostics/services, effective August 1, 2026. Prior authorization will be mandatory for all nonparticipating providers and inpatient service requests.
Action Required
By August 1, 2026: Billing team must update system to require prior authorization for all 90+ listed codes across DME, hearing services, inpatient facility services, and outpatient diagnostics/services for CareSource Georgia Medicaid patients. Program billing software to automatically flag these codes for prior auth verification. Train staff to use CareSource Procedure Lookup Tool for real-time prior auth verification. Update encounter forms and EMR templates to alert providers. Claims will be denied without proper prior authorization.