Office of Analytics and Program Improvement, Medicaid Promoting Interoperability Program. Before sharing sensitive or personal information, make sure youre on an official state website. Additionally, laws and regulations and insurance and payer policies are subject to change. They include, but are not limited to claims processing guidelines referenced by the Centers for Medicare and Medicaid Services (CMS), Publication 100-04, Claims Processing Manual for physicians/non-physician practitioners, the CMS National Correct Coding Initiative policy manual (procedure-to-procedure coding combination edits and medically unlikely edits), Current Procedural Technology guidance published by the American Medical Association (AMA) for reporting medical procedures and services, health plan clinical policies based on the appropriateness of health care and medical necessity, and at times state-specific claims reimbursement guidance. The Department of Community Health (DCH) administers Medicaid reimbursement and associated policy for mental health treatment and services through partnership with The Department of Behavioral Health and Developmental Disabilities (DBHDD). FY 2021 revised rates inclusive of 18.37% Growth and Quality Incentive Please note that the reimbursement rate sheets (R-32) are in alphabetical order. Other non-clinical policies (e.g., payment policies) or contract terms may further determine whether a technology, procedure or treatment that is not addressed in the Clinical Policy Manuals or InterQualcriteria is payable by Peach State Health Plan. The Initial Reimbursement Rate Sheets for FYE June 30, 2022, are located below. Please enable Cookies and reload the page. Each state determines reimbursement rates and coverage of services. The Department of Community Heath received approval from the Center of Medicare and Medicaid Services (CMS) for a temporary 5% growth increase effective July 1, 2020 through June 30, 2021 for all nursing home providers. Copyright CareSource 2023. Georgia Georgia Medicaid Coverage of Therapy Services Georgia Medicaid Coverage of Therapy Services Guidance on therapy services covered through Georgia Medicaid and other important compliance issues such as enrollment, billing, audits, and managed care. The analysis of any legal or medical billing is dependent on numerous specific facts including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. They are routinely updated to promote accurate coding and policy clarification. According to Georgia Medicaid guidelines, early and periodic screening, diagnostic and treatment (EPSDT) services should follow the recommended age requirement indicated in the American Academy of Pediatrics (AAP) and Bright Futures 'Recommendations for Pediatric Health Care' periodicity schedule. Georgia Medicaid Coverage of Therapy Services Community providers of behavioral health services can be accessed by contacting The Georgia Crisis and Access Line (GCAL) at 800-715-4225 or via the web by visiting www.mygcal.com. The information contained in this web site is intended as general information only. Please enable it in order to use the full functionality of our website. Policies in the Peach State Health PlanClinical Policy Manual may have either a Peach State Health Planor a Centene heading. NC Medicaid Contact Center How you know. Authorization for Cancer Treatment/New Century Health, 25-Hydroxyvitamin D Testing in Children and Adolescents (PDF), Allogeneic Hematopoietic Cell Transplants for Sickle Cell(PDF), Ambulatory Surgery Center Optimization (PDF), Cosmetic and Reconstructive Surgery (PDF), Diaphragmatic/Phrenic Nerve Stimulation (PDF), Drugs of Abuse: Definitive Testing (PDF), Facility-based Sleep Studies for Obstructive Sleep Apnea (PDF), Genetic Testing Aortopathies and Connective Tissue Disorder (PDF), Genetic Testing Dermatologic Conditions (PDF), Genetic Testing Epilepsy Neurodegenerative Neuromuscular Disorder (PDF), Genetic Testing Exome and Genome Sequencing for the Diagnosis of Genetic Disorders (PDF), Genetic Testing Gastroenterologic Disorders (non-cancerous) (PDF), Genetic Testing General Approach to Genetic Testing (PDF), Genetic Testing Hematologic Conditions (non-cancerous) (PDF), Genetic Testing Hereditary Cancer Susceptibility (PDF), Genetic Testing Immune Autoimmune and Rheumatoid Disorders (PDF), Genetic Testing Metabolic Endocrine and Mitochondrial Disorders(PDF), Genetic Testing Multisystem Inherited Disorders, Intellectual Disability and Developmental Delay(PDF), Genetic Testing Non-Invasive Prenatal Screening (NIPS)(PDF), Genetic Testing Preimplantation Genetic Testing(PDF), Genetic Testing Prenatal and Precon Carrier Screening(PDF), Genetic Testing Prenatal Diagnosis (via Amnio CVS or PUBS) and Pregnancy Loss(PDF), Genetic Testing Skeletal Dysplasia and Rare Bone Disorders(PDF), Helicobacter Pylori Serology Testing (PDF), Implantable Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (PDF), Implantable Wireless Pulmonary Artery Pressure Monitoring (PDF), Infant Apnea Monitors Clinical Policy (PDF), Intestinal and Multivisceral Transplant (PDF), Intradiscal Steroid Injections for Pain Management(PDF), IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures(PDF), Low-Frequency Ultrasound Therapy for Wound Management (PDF), Measurement of Serum 1,25-dihydroxyvitamin D (PDF), Neonatal Abstinence Syndrome Guidelines (PDF), Nerve Blocksand Neurolysis for Pain Management (PDF), Neuromuscular Electrical Stimulation (PDF), Nonmyeloablative Allogeneic Stem Cell Transplants (PDF), Oncology Circulating Tumor DNA and Circulating Tumor Cells (PDF), Oncology Molecular Analysis of Solid Tumors and Hematologic Malignancies (PDF), Percutaneous Left Atrial Appendage Closure Device for Stroke Prevention (PDF), Phototherapy for Neonatal Hyperbilirubinemia(PDF), Physical, Occupational, and Speech Therapy Services (PDF), Physical, Occupational, Speech, and Feeding Therapy (PDF), Posterior Tibial Nerve Stimulation for Voiding Dysfunction (PDF), Reduction Mammoplasty and Gynecomastia Surgery (PDF), Sacroiliac Joint Interventions for Pain Management (PDF), Sclerotherapy and Chemical Endovenous Ablation for Varicose Veins(PDF), Selective Dorsal Rhizotomy for Spasticity in Cerebral Palsy (PDF), Selective Nerve Root Blocks and Transforaminal Epidural Injections for Pain Management (PDF), Skin Substitutes for Chronic Wounds (PDF), Spinal Cord, Peripheral Nerve, and Percutaneous Electrical Nerve Stimulation (PDF), Stereotactic Body Radiation Therapy (PDF), Testing for Select Genitourinary Conditions (PDF), Total Parenteral Nutrition and Intradialytic Parenteral Nutrition (PDF), Transcather Closer of Patent Foramen Ovale (PDF), Transplant Service Documentation Requirements, Trigger Point Injections for Pain Management (PDF), Urinary Incontinence Devices and Treatments (PDF), IV Moderate Sedation, IV Deep Sedation, and General Anesthesia for Dental Procedures (PDF), Non-myeloablative Allogeneic Stem Cell Transplants (PDF), Physical, Occupation, and Speech Therapy Services, Sclerotherapy and chemical endovenous ablation for Varicose Veins(PDF), Transcatheter Closure of Patent Foramen Ovale (PDF), Behavioral Health Treatment Document Requirement(PDF), Deep Transcranial Magnetic Stimulation for Obsessive Compulsive Disorder (PDF), Substance Use Disorder Treatment and Services (PDF), Biofeedback for Behavioral Health Disorders (PDF), Transcranial Magnetic Stimulation for Treatment Resistant Major Depression (PDF), Adjacent Tissue Transfer Grafts involving Eyelid (PDF), Anterior Segment Photography with FA (PDF), Blepharoplasty, Ptosis and Canthoplasty (PDF), Dark Adaptation and Color Vision Examinations (92283/92284) (PDF), Destruction of a Localized Lesion of the Retina (PDF), Destruction of Localized Lesion of Choroid (PDF), Examination Guidelines for Diabetic Patients (PDF), Indocyanine Green (ICG) Angiography (PDF), Infracture of the Inferior Turbinate (PDF), Laser Iridotomy and Iridectomy for Glaucoma (PDF), Photodynamic and Intravitreal Therapies and Pharmaceuticals (PDF), Probing and Closure of the Lacrimal Duct System (PDF), Surgical Excision of Eyelid Lesions (PDF), Teleretinal Screening for Diabetic Retinopathy (PDF), Ado-Trastuzumab Emtansine (Kadcyla) (PDF), Age Limit Override (Codeine, Tramadol, Hydrocodone) (PDF), Alendronate (Binosto, Fosamax plus D) (PDF), Alpha-1 Proteinase Inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) (PDF), Antithymocyte Globulin (Thymoglobulin, Atgam) (PDF), Anti-Inhibitor Coagulant Complex, Human (Feiba) (PDF), Aprepitant (Emend, Cinvanti), Fosaprepitant (Emend for injection) (PDF), Aripiprazole Long-Acting Injections (Abilify Maintena, Aristada) (PDF), Baclofen (Gablofen, Lioresal, Ozobax) (PDF), Bevacizumab (Avastin, Mvasi, Zirabev) (PDF), Blocking Adjudication of Controlled Substance Prescriptions for Selected Prescribers(PDF), Brand Name Override and Non-Formulary Medications (PDF), Brexucabtagene Autoleucel (Tecartus)(PDF), Brinzolamide/Brimonidine (Simbrinza) (PDF), Budesonide Suspension (Pulmicort Respules) (PDF), Buprenorphine Implant/Injection (Probuphine, Sublocade) (PDF), Buprenorphine-Naloxone (Bunavail, Cassipa, Suboxone) (PDF), C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda) (PDF), C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda, Ruconest) (PDF), Cabozantinib (Cometriq, Cabometyx) (PDF), Ciprofloxacin-Dexamethasone (Ciprodex) (PDF), Ciprofloxacin/Fluocinolone (Otovel) (PDF), Clindamycin Phosphate/Benzoyl Peroxide (BenzaClin) (PDF), Clinical Pharmacy Services Inter-rater Reliability (PDF), Conjugated Estrogens/Bazedoxifene (Duavee) (PDF), Corticosteroid Intravitreal Implants (Iluvien, Ozurdex, Retisert, Yutiq) (PDF), Cysteamine oral (Cystagon, Procysbi) (PDF), Cytomegalovirus Immune Globulin (Cytogam)(PDF), Desmopressin Acetate (DDAVP, Stimate, Noctiva) (PDF), Dextromethorphan-Quinidine (Nuedexta) (PDF), Dimethyl Fumarate (Tecfidera), Diroximel Fumarate (Vumerity) (PDF), Dipeptidyl Peptidase-4 (DPP-4) Inhibitors (PDF), Doxepin (Silenor, Prudoxin, Zonalon) (PDF), Doxycycline Hyclate (Acticlate, Doryx), Doxycycline (Oracea) (PDF), Early and Periodic Screening, Diagnostic, and Treatment Benefit for Pediatric Members (PDF), Elexacaftor/Ivacaftor/Tezacaftor; Ivacaftor (Trikafta) (PDF), Emtricitabine/Tenofovir Alafenamide (Descovy)(PDF), Everolimus (Afinitor, Afinitor Disperz, Zortress) (PDF), Factor IX Complex, Human (Profilnine) (PDF), Factor VIIa, Recombinant (NovoSeven RT) (PDF), Factor VIIa, Recombinant (NovoSeven RT, SevenFact) (PDF), Factor XIII A-Subunit, Recombinant (Tretten) (PDF), Fam-trastuzumab Deruxtecan-nxki (Enhertu) (PDF), Fentanyl IR (Abstral, Actiq, Fentora, Lazanda, Subsys) (PDF), Filagrastim (Neupogen), Filagrastim-sndz (Zarxio), Tbo-filagrastim (Granix) (PDF), Formulary Medications without Specific Guidelines (PDF), Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists (PDF), Granisetron (Kytril, Sancuso, Sustol) (PDF), histrelin acetate (Vantas, Supprelin LA) (PDF), Hydroxyprogesterone Caproate (Makena/compound), Indacaterol/Glycopyrrolate (Utibron Neohaler) (PDF), Infertility and Fertility Preservation (PDF), Infliximab (Remicade, Inflectra, Renflexis) (PDF), Insulin Delivery Systems (V-Go, OmniPod, InPen) (PDF), Interferon beta-1b (Betaseron, Extavia) (PDF), Intrathecal Baclofen (Gablofen, Lioresal) (PDF), Isotretinoin (Absorica, Absorica LD, Amnesteem, Claravis, Myorisan, Zenatane) (PDF), Itraconazole (Sporanox, Onmel, Tolsura) (PDF), Lesinurad (Zurampic), Lesinurad/Allopurinol (Duzallo) (PDF), leuprolide acetate (Eligard, Lupaneta Pack, Lupron Depot, Lupron Depot-Ped) (PDF), Levalbuterol (Xopenex HFA/Inhalation Solution) (PDF), Lidocaine Transdermal (Lidoderm, ZTlido) (PDF), Lutetium Lu 177 Dotatate (Lutathera)(PDF), Montelukast oral granules (Singulair) (PDF), Methotrexate (Otrexup, Rasuvo, Xatmep, Reditrex) (PDF), Methoxy polyethylene glycol-epoetin beta (Mircera) (PDF, Methylnaltrexone Bromide (Relistor) (PDF), Minocycline ER (Solodyn, Ximino, Minolira) and Microspheres (Arestin) (PDF), Moxetumomab pasudotox-tdfk (Lumoxiti) (PDF), Multiple Procedure Payment Reduction (MPPR) for Therapeutic Services (PDF), Nadofaragene Firadenovec (Instiladrin) (PDF), Naproxen oral suspension (Naprosyn) (PDF), Neomycin/Fluocinolone Cream (Neo-Synalar)_(PDF), Netarsudil (Rhopressa), Netarsudil/Latanoprost (Rocklatan) (PDF), Netupitant and Palonosetron (Akynzeo), Fosnetupitant and Palonosetron (Akynzeo IV) (PDF), No Coverage Criteria/Off-Label Use Policy (PDF), Non-Formulary and Formulary Contraceptives (PDF), Octreotide (Sandostatin, Sandostatin LAR) (PDF), Octreotide Acetate (Sandostatin, Sandostatin LAR Depot, Bynfezia) (PDF), Olanzapine Long-Acting Injection (Zyprexa Relprevv)(PDF), Onasemnogene Abeparvovec (Zolgensma) (PDF), Paclitaxel, Protein-Bound (Abraxane) (PDF), Peanut Allergen Powder-dnfp (Palforzia) (PDF), Pegaspargase (Oncaspar), Calaspargase pegol-mknl (Asparlas) (PDF), peginterferon alfa-2b (PegIntron, Sylatron) (PDF), Pharmacy and Therapeutics Committee(PDF), Pharmacy Prior Authorization and Medical Necessity Criteria(PDF), Potassium Chloride for Oral Solution (Klor-Con Powder) (PDF), Propranolol HCl Oral Solution (Hemangeol) (PDF), Protein C Concentrate, Human (Ceprotin) (PDF), Repository Corticotropin Injection (H.P.
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