Web form outage is expected around 5:30pm on April 28, 2023. Not already Contracted to Sell for CareSource? 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. Medicaid Coverage of Speech-Language Pathologists and Audiologists In addition, Peach State Health Planmay from time to time delegate utilization management of specific services; in such circumstances, the delegated vendors guidelines may also be used to support medical necessity and other coverage determinations. According to Georgia Medicaid guidelines, the children's intervention services reported with certain modifiers are limited to the assigned units for that modifier or modifier combination that are included in the Policies and Procedures Manual for Children's Intervention Services. Maximum Units are specific to crisis intervention services (H2011) provided in a Skilled nursing facility or a Nursing facility, as they are limited to 144 units per year when billed with the following modifier combinations: According to Georgia Medicaid guidelines, crisis intervention services should be reported with modifier U6 (In-Clinic), U7 (Out-of-Clinic), or telehealth (GT) modifier. Section 1902(a)(30)(A) of the Social Security Act requires that such payments be consistent with efficiency, economy, and quality of care, and are sufficient to provide access equivalent to the general population. Background Speech language pathology services include the diagnosis and treatment of speech and language disorders. Reimbursement policies are designed to assist you when submitting claims to CareSource. 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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