Georgia Billing Guide for Mental Health Therapists and Psychiatrists
Who pays, where to enroll and which rules change your claims in Georgia, for psychotherapists and psychiatric prescribers.
Last checked October 25, 2026. Reviewed against the official sources listed at the bottom of this page.
This Georgia billing guide covers Medicaid, Medicare, Blue Cross, other private payers and state law for therapists and psychiatrists, with sources and a last-checked date.
Georgia billing guide: how Georgia pays for outpatient care
Georgia Medicaid and PeachCare for Kids are run by the Department of Community Health (DCH). Most members get care through Georgia Families, where three care management organizations (CMOs) pay claims, so you bill the member's health plan, not Gainwell. Gainwell Technologies is the fiscal agent for fee-for-service claims through the GAMMIS portal.
Georgia Pathways to Coverage, the state's limited expansion program, already carries a work requirement, and its federal authority expires December 31, 2026 unless renewed. Medicare Part B claims go to Palmetto GBA in Jurisdiction J.
Who to bill, at a glance
| Payer type | Who you bill | Where to enroll or check rules |
|---|---|---|
| Medicaid | Georgia Department of Community Health (DCH); CMOs for Georgia Families, Gainwell for fee-for-service | Georgia Medicaid portal (GAMMIS) |
| Medicare Part B | Palmetto GBA, Jurisdiction J | CMS MAC page |
| Blue Cross Blue Shield | Anthem Blue Cross and Blue Shield (Georgia) | See the Blue Cross section below |
Georgia Medicaid: Georgia Families
This Georgia billing guide starts with Medicaid, because it decides who pays and how you file.
Georgia Medicaid is mixed. Georgia Families members receive care through CMOs, and providers file claims with the member's plan. Fee-for-service members are billed through GAMMIS and Gainwell.
Behavioral health is not carved out to a single vendor in the sources we reviewed. Community Behavioral Health Rehabilitation Services (CBHRS) require agencies to be determined eligible by the Department of Behavioral Health and Developmental Disabilities (DBHDD), national accreditation and prior authorization. Effective 1/1/2026, CBHRS includes class of service 440 and Certified Community Behavioral Health Services (class of service 443).
| Item | What to know |
|---|---|
| Agency | Georgia Department of Community Health |
| Fiscal agent and portal | Gainwell Technologies, GAMMIS web portal |
| Fee-for-service psychology and therapy manual | Psychology and Therapy Services manual, October 2024. Fee-for-service psychotherapy is limited to 24 units per member per calendar year before prior authorization through Alliant Health Solutions, and this manual covers members under 21. |
| CBHRS manual | Community Behavioral Health Rehabilitation Services manual, April 2026 |
| Revalidation | GAMMIS alerts state that providers who had not completed revalidation were to be suspended effective July 1, 2026, and claims with dates of service on or after that date would not be paid. Source |
| Work requirement | Georgia Pathways already requires 80 hours per month of qualifying activity for adults 19 to 64 up to 100% of the federal poverty level. A CMS letter dated 9/25/2026 says Georgia must implement the federal community engagement requirement for the Pathways population no later than 1/1/2027. The demonstration authorities expire 12/31/2026 unless renewed or amended. Source |
Managed-care plans and carve-outs
| Plan or entity | Role in behavioral health |
|---|---|
| Amerigroup | Incumbent CMO per the DCH April 23, 2026 update. |
| CareSource | Incumbent CMO. Policy MCD-PY-1767 on psychotherapy add-on codes took effect 7/1/2026. |
| Peach State Health Plan | Incumbent CMO per the DCH April 23, 2026 update. |
CMO transition: DCH's April 23, 2026 update says the CMO procurement is in the protest phase, no Notice of Award has issued, and current contracts will be extended through June 30, 2027. Check the DCH Georgia Families page before you change any contracting.
Medicare Part B in Georgia
For Medicare, this Georgia billing guide names your contractor and the current telehealth rules.
Medicare Part B pays for outpatient psychotherapy and psychiatric visits billed to the Medicare Administrative Contractor (MAC) for your state. CMS's July 14, 2026 fact sheet on the CY2027 Physician Fee Schedule proposed rule says the Consolidated Appropriations Act, 2026 extended telehealth payment authority through December 31, 2027, and proposes that in-person visit requirements for mental health visits not apply to services furnished through that date.
| Item | What to know |
|---|---|
| Contractor | Palmetto GBA, LLC |
| Jurisdiction | Jurisdiction J: Alabama, Georgia and Tennessee |
| Source | CMS.gov MAC page |
Blue Cross Blue Shield in Georgia
This part of the Georgia billing guide names the exact Blue Cross licensee, because Blue plans never share rules.
Blue Cross Blue Shield is a federation of independent companies, so one licensee's rules never apply to another. In Georgia that is Anthem Blue Cross and Blue Shield, a brand of Elevance Health. Elevance's SEC filing describes it as an independent licensee of the Blue Cross and Blue Shield Association and lists Georgia as a licensee state.
| Licensee | Parent or affiliation | Where it applies | Provider resources |
|---|---|---|---|
| Anthem Blue Cross and Blue Shield (Georgia) | Elevance Health; independent licensee of the Blue Cross and Blue Shield Association | Georgia | Elevance SEC filing |
Other private payers and EAPs in Georgia
The Georgia billing guide also covers commercial plans and employee assistance programs.
These commercial payers and plan families most often matter for behavioral health billing in Georgia. Check each payer's current provider manual before you submit.
| Payer | Behavioral health note | Provider resources |
|---|---|---|
| Anthem Blue Cross and Blue Shield | Anthem reimbursement policy G-06133, Proof of Timely Filing (effective 10/23/2025), lists Georgia among its states. Confirm the commercial timely filing limit in the Anthem provider manual. | Official page |
| CareSource (Georgia Medicaid) | Policy MCD-PY-1767, effective 7/1/2026: psychotherapy add-on codes deny when billed with certain high-level E/M codes for the same patient, provider TIN and date of service. The E/M still pays. | Official page |
| Amerigroup (Georgia Medicaid) | Policy G-06050 (effective 6/3/2025): initial claims are due six months following the month services were rendered. | Official page |
Georgia billing guide: state law that changes billing
Use this section of the Georgia billing guide to separate state law from payer policy.
State law sets the floor for commercial plans in Georgia. Medicare and Medicaid rules are covered in their own sections above.
Mental health parity
Georgia's parity law is HB 1013 (2022), effective July 1, 2022. It requires insurers to cover mental health and substance use treatment on the same footing as physical care and limits denials based on insurer-developed guidelines. DCH says complaints about private plans go to the Office of the Commissioner of Insurance and Safety Fire. Source
Telehealth coverage and payment parity
O.C.G.A. 33-24-56.4, as amended by SB 118 (effective 1/1/2020), bars insurers from excluding a covered service solely because it is delivered by telemedicine and requires reimbursement on the same basis and at least at the rate of the same in-person service. Georgia Medicaid CBHRS telemedicine requires two-way real-time audio and video, the GT modifier and a signed consent form. Source
Prompt payment and timely filing
Fee-for-service Medicaid psychology and therapy claims are due within six months of the date of service. Source
Practitioner scope: therapists and prescribers
The fee-for-service manual lists psychologists, LMFTs, LCSWs and professional counselors as provider types, but psychotherapy in Section 805, testing codes 96130 to 96133 and group 90853 are restricted to enrolled psychologists, and members must be under 21. For prescribers, federal DEA telemedicine controlled-substance flexibilities were extended through December 31, 2026. Source
Not legal advice. Confirm statute details with counsel.
Georgia billing guide: codes and rates
This Georgia billing guide lists only codes and rates confirmed on official pages.
These are the Georgia-specific codes, modifiers and rate items confirmed on official pages. Medicare's own CY2027 conversion factor proposal is listed under What changed.
| Code or item | What to know |
|---|---|
| 90791, 90832, 90834, 90837 and 90853 (fee-for-service, members under 21) | October 2024 manual rates: 90791 $128.24, 90832 $53.22, 90834 $68.44, 90837 $111.16, 90853 $28.92. Verify the current fee schedule in GAMMIS. Source |
| CBHRS modifiers U1 to U4, U6, U7 and GT; H0031, H2011 and 90832 | April 2026 manual: U1 to U4 mark practitioner levels, U6 in-clinic, U7 out-of-clinic, GT telemedicine. H0031 and H2011 allow up to 10 daily units. Time-based codes round in 15-minute units (8 to 22 minutes equals 1 unit). Source |
| 90833, 90836 and 90838 with 99204, 99205, 99214 or 99215 (CareSource Georgia Medicaid) | Policy MCD-PY-1767, effective 7/1/2026: the add-on denies and the E/M pays. Psychotherapy add-ons need start and stop times. Source |
Georgia billing guide: what changed, newest first
Check this Georgia billing guide update log before you rely on an older rule.
| Date | What changed | Source |
|---|---|---|
| 2027-01-01 | Federal community engagement requirement must be in place for Georgia Pathways, per the CMS letter dated 9/25/2026. | Source |
| 2026-12-31 | Georgia Pathways demonstration authorities expire unless renewed or amended. | Source |
| 2026-09-25 | CMS letter conforms Georgia Pathways to P.L. 119-21. | Source |
| 2026-07-14 | CMS released the CY2027 Medicare Physician Fee Schedule proposed rule: conversion factor $32.84 for non-qualifying APM participants (down 1.68%) and $33.17 for qualifying participants (down 1.19%). | Source |
| 2026-07-01 | GAMMIS revalidation suspension date. CareSource Georgia Medicaid policy MCD-PY-1767 takes effect. | Source |
| 2026-06-01 | CMS issued the Medicaid community engagement interim final rule. States must generally implement by 1/1/2027. | Source |
| 2026-04-23 | DCH update: Georgia Families CMO procurement is in the protest phase, and current contracts will be extended through June 30, 2027. | Source |
| 2026-01-01 | Georgia Medicaid CBHRS includes class of service 440 and CCBHS class of service 443. | Source |
How do I bill mental health claims in Georgia?
These answers come from the same sources as the rest of this Georgia billing guide.
Start with the member's payer type. For Georgia Medicaid, bill the member's CMO (Amerigroup, CareSource or Peach State Health Plan) for Georgia Families members, and GAMMIS for fee-for-service. Medicare Part B goes to Palmetto GBA in Jurisdiction J. Anthem Blue Cross and Blue Shield is the Blue licensee for commercial members.
Questions about billing in Georgia
Who do I bill for Georgia Medicaid behavioral health claims?
For Georgia Families members, bill the member's CMO (Amerigroup, CareSource or Peach State Health Plan), not Gainwell. Fee-for-service members are billed through GAMMIS and Gainwell.
What is happening with the Georgia Medicaid CMO transition?
DCH's April 23, 2026 update says the procurement is in the protest phase, no Notice of Award has issued, and current CMO contracts will be extended through June 30, 2027. Check the DCH Georgia Families page for updates.
What happens to Georgia Pathways at the end of 2026?
The Pathways demonstration authorities expire December 31, 2026 unless renewed or amended. A CMS letter dated September 25, 2026 says Georgia must implement the federal community engagement requirement for Pathways by January 1, 2027.
What is the Georgia Medicaid timely filing limit?
For fee-for-service psychology and therapy claims, six months from the date of service. Amerigroup's Georgia Medicaid policy allows initial claims six months following the month services were rendered. Check each plan's manual.
Does MCM South bill for practices in Georgia?
MCM South serves Georgia. Request a quote to talk through your practice.
Sources for the Georgia billing guide
Last checked October 25, 2026. Every source below was opened and read on that date.
- Georgia Families updates (DCH), checked October 25, 2026
- Georgia Medicaid portal (GAMMIS), checked October 25, 2026
- Georgia Medicaid Psychology and Therapy Services manual, checked October 25, 2026
- Georgia Medicaid CBHRS manual, April 2026, checked October 25, 2026
- CMS letter to Georgia on Pathways, 9/25/2026, checked October 25, 2026
- CMS fact sheet: Medicaid community engagement interim final rule, checked October 25, 2026
- DCH: Georgia mental health parity, checked October 25, 2026
- SB 118 signed legislation, checked October 25, 2026
- CareSource Georgia policy MCD-PY-1767, checked October 25, 2026
- Amerigroup Georgia Medicaid timely filing policy, checked October 25, 2026
- Anthem reimbursement policy G-06133, checked October 25, 2026
- CMS: CY2027 Physician Fee Schedule proposed rule fact sheet, checked October 25, 2026
- CMS MAC jurisdiction page, checked October 25, 2026
Related guides
- State & Regional Billing Guides hub
- Georgia insurance companies contact guide
- In-network vs out-of-network credentialing
- Credentialing and network status
- Blue Cross Blue Shield guide for Georgia
- Georgia Medicaid billing codes
- Mental health parity explained
- Medicaid managed care billing
- Medicare behavioral health billing
- Timely filing in the billing glossary
- Who we serve
- Tennessee insurance companies contact guide
Billing in Georgia? Let us handle the payer calls.
MCM South bills only mental and behavioral health, for psychotherapists and psychiatrists, in solo and medium-size practices. We serve Georgia.
MCM South currently serves practices in ten states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois.