---
title: "Georgia Medicaid ABA coverage: the intake guide."
url: "https://carelu.com/payers/georgia-medicaid"
markdown_url: "https://carelu.com/payers/georgia-medicaid.md"
state: GA (Georgia)
payer: Georgia Medicaid
kind: State Medicaid program
description: "How Georgia Medicaid (DCH) covers ABA: eligibility under EPSDT, Katie Beckett access, prior authorization, required documents, CPT codes and modifiers — an intake-focused guide for ABA providers."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Georgia Medicaid ABA coverage: the intake guide.

_Payer Guide · Georgia Medicaid · Last updated September 2026 · 11 primary sources_

> EPSDT under 21, Katie Beckett path, CMO landscape, PA packages.

Georgia Medicaid covers ABA — the state calls it Adaptive Behavior Services (ABS) — for members under 21 through EPSDT, and Georgia is one of the highest-demand ABA states in the country. But the benefit runs through a thicket of DCH manual rules, CMO-specific policies, and a managed-care transition in flight. Here's what an intake team actually needs to know.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — a separate prior authorization for the behavioral assessment [2]
- **Prior auth for treatment**: Required — separate PA, issued in 6-month increments [2]
- **Autism diagnosis required?**: Yes — documented DSM-5 ASD diagnosis (EPSDT ABS benefit) [2]

## At a glance

- **Covers ABA?:** Yes — under 21, via EPSDT (since Jan 2018)
- **Prior auth:** Required for assessment AND treatment, separately
- **Auth increments:** 6-month treatment authorizations
- **Typical hours:** 10–30 hrs/week; more if medically necessary
- **Middle-income path:** Katie Beckett waiver (income ignored)
- **Managed care:** CMOs administer PA under their own aligned policies
- **Diagnosis recency:** Eval instruments within 5 years; outside assessments within 6 months
- **Staff screening:** GCIC+FBI fingerprints for licensed analysts; BACB 180-day check is the only technician-level screen

## Who qualifies

Coverage applies to Medicaid members under age 21 with a documented DSM-5 ASD diagnosis established by a licensed physician, psychologist, or other qualifying professional using evidence-based tools — per current CMO operationalizations, a comprehensive diagnostic evaluation generally needs at least two instruments (one clinician-administered like ADOS-2 or CARS-2, plus one caregiver tool like ADI-R or SRS-2) within the last five years. School psychoeducational assessments don't qualify. [2][3]

The detail most intake teams miss: families who "make too much for Medicaid" often still qualify through the Katie Beckett (TEFRA) deeming waiver — family income is ignored, and qualification is based on the child's level of care. It confers full Medicaid eligibility, which unlocks the ABA benefit. An online Katie Beckett application portal launched in April 2026. If your intake process turns away middle-income families without mentioning Katie Beckett, you're losing eligible families. [2][3]

## Prior authorization

Everything is prior-authorized: one PA for the behavioral assessment, a separate PA for treatment, requested by the enrolled QHCP (licensed physician, psychologist, BCBA-D, or BCBA — BCaBAs and RBTs cannot serve as the QHCP). Treatment authorizations come in 6-month increments; fee-for-service PAs go through the GAMMIS portal, while CMO members follow their plan's process. [2]

- **The treatment PA package:** Diagnosis + summarized assessment results, proposed Plan of Care (documenting all other services), IFSP/IEP if applicable, psych assessment if applicable, progress notes, and — for CMOs — a Letter of Medical Necessity and the Medicaid cover page. [2]
- **Assessment recency:** Outside assessments are accepted if dated within 6 months of the request; comprehensive assessments are generally capped at 8 hours per 6-month period. [2]
- **Reauthorization every 6 months:** Requires a behavior assessment conducted within 2 months of the requested effective date, progress vs. prior goals (with graphs), and updated individualized goals. [2]

## The CMO landscape (and why it matters for intake)

ABA is not carved out of managed care — most members are in a CMO (CareSource, Peach State, Amerigroup today), and each administers prior auth under its own policy aligned to the DCH manual. December 2024 awards went to CareSource, Humana, Molina, and UnitedHealthcare, but as of this review (8/1/2026) the re-procurement still has not gone live: per DCH's own "Georgia Families — Latest News" page (updated 4/23/2026), the procurement remains in the protest phase pending a Notice of Award, and DCH has extended the current CMO contracts — Amerigroup, CareSource, and Peach State — through June 30, 2027, with no go-live date yet announced for the 2024 awardees. Amerigroup and Peach State carry no other status change beyond that extension. For intake, the practical rule: always capture which CMO the family is enrolled in — it determines the PA process, forms, and timelines you'll be working against — and don't assume the new awardees are live until DCH announces a transition date. [1][4][5][11]

## Billing basics your intake data feeds

Georgia reimburses CPT 97151–97158, 0362T, and 0373T in 15-minute units, with practitioner-level modifiers (U1–U5) and setting modifiers — U6 in-clinic, U7 out-of-clinic at a higher rate, GT telehealth. Georgia is unusual in paying different rates by setting, which makes the family's preferred setting (home vs. center) an intake question with direct revenue implications. Telehealth is billable only if the rendering provider is in Georgia or within 50 miles of the border. [2]

## Staffing & credentialing: who you can hire, and what they must clear

Georgia licensure is new and the deadlines have already passed. HB 412 created O.C.G.A. Title 43, Chapter 7A effective July 1, 2023: behavior analysts and assistant behavior analysts must now be licensed by the Georgia Behavior Analyst Licensing Board (under the Secretary of State), and unlicensed practice carries a $1,000 fine per violation. Every license applicant must clear a GCIC + FBI fingerprint record check at their own expense — filing the application is express consent. The Board required behavior analysts to file complete applications by September 30, 2025 and assistants by March 31, 2026; anyone who missed those dates may be treated as practicing without a license. (Sourcing caveat: those deadlines are confirmed on secondary sources — the Board's own pages on sos.ga.gov block automated retrieval — so verify current status with the Board directly.) Licenses run two years and require maintaining active BCBA/BCaBA certification. [6][7][8][2][9][5]

The Medicaid staffing structure runs through the QHCP. Only a licensed physician, psychologist, BCBA-D, or BCBA can be the enrolled QHCP, and each may supervise up to six BCaBAs and RBTs at any point in time — a hard ratio that caps how many technicians one BCBA can carry. A BCaBA must be supervised by a BCBA/BCBA-D but may in turn supervise RBTs; an RBT can never be the QHCP. Every direct-care professional (RBTs included) must attest to one year of experience serving youth with ASD on the Department's Attestation form, which must be updated and resubmitted within two weeks of any staffing change — a compliance chore intake and HR should share. Supervision doesn't require the supervisor on site, but both supervisor and supervisee must keep contemporaneous records of each session's date, duration, type, and content; discrepancies subject the associated claims to recoupment. [6][7][8][2][9][5]

At the technician level, Georgia is notably light on state screening: technicians are exempt from licensure (they must use nonprofessional titles like "behavior technician"), and neither the statute nor the publicly posted ASD manual imposes a state background-check, fingerprint, or registry mandate on them — the operative screen is the BACB's own: a criminal background check plus abuse-registry check within 180 days before the RBT application, with 5%-of-hours monthly supervision and at least two face-to-face contacts per month. Plan-level extras do bind: Peach State requires protocol modification (BCBA-level case direction) at ≥2 hours/week or 10% of direct service hours (whichever is greater), and 0373T sessions must include a BCBA onsite and immediately available. One honest gap: the ASD manual publicly posted is the January 2018 version, and current quarterly manuals plus enrollment-screening detail live inside GAMMIS, which blocks public access — confirm staff-level exclusion-screening expectations (OIG LEIE / SAM.gov cadence) with DCH provider enrollment. [6][7][8][2][9][5]

## Intake gates

The questions that decide whether a family can start with Georgia Medicaid, and what they have to bring.

- **Age limit**: Under 21. The posted ASD manual states it plainly under General Eligibility: “Autism Spectrum Services are for individuals under the age of 21.” The current DCH Telehealth Guidance (version date 10/1/2025) confirms the same footing from a document that is not stale — ASD assessment and treatment are “provided to Medicaid beneficiaries in accordance with the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Benefit and according to medical necessity.” Two further eligibility conditions sit alongside the age bound: “children must be able to participate in sessions,” and caregivers “must be able to participate in ABS therapy and have the ability to implement ABS techniques in the home environment.” [2][10]
- **Diagnosis recency**: The posted manual sets one recency rule, and it is about the assessment rather than the diagnosis: “Medicaid will accept for submission the findings from an assessment that was not approved/covered by Medicaid… as long as the assessment was conducted/dated no more than six (6) months prior to the treatment PA request submission.” On the diagnosis itself the manual says only that it “should be made and confirmed in early childhood.” The five-year evaluation window Georgia families actually meet is a CMO operationalisation, not a posted state rule — CareSource requires a diagnostic re-evaluation when “the initial diagnosis is at least 5 years old with no evidence of ongoing assessment and treatment,” and Peach State requires the CDE to have been “completed within the last five years” at treatment initiation. Sourcing caveat: the ASD manual publicly posted on medicaid.georgia.gov is the January 2018 version and is known to be stale — its Appendix A still prices the retired 0359T–0374T code set — while the current quarterly manuals and live fee schedule sit inside GAMMIS (mmis.georgia.gov), which refuses automated clients outright. [2][4][5]
  - Ask the plan: The current ASD manual inside GAMMIS (mmis.georgia.gov) for whether DCH has since adopted the five-year window itself; in the meantime route by the member’s CMO policy.
- **Who may diagnose**: Two requirements stack. Credential: “a documented diagnosis of ASD must be established by a licensed physician or psychologist, or other licensed professional as designated by the Medical Composite Board in order to perform a behavioral assessment and develop a resulting Plan of Care.” Experience: “the diagnosis must be made by a practitioner with one year of experience in serving individuals with an autism diagnosis who is also enabled by the OCGA practice acts to diagnose behavioral health/intellectual/developmental conditions” — a one-year ASD-experience test on the diagnostician that intake should actually check, not assume. The enrolled QHCP then re-validates at assessment: “based on the assessment, the QHCP validates the individual’s diagnosis of ASD and identifies the severity level… according to the DSM-5 manual,” and if the diagnosis is not validated the QHCP refers the member elsewhere. Sourcing caveat: the ASD manual publicly posted on medicaid.georgia.gov is the January 2018 version and is known to be stale — its Appendix A still prices the retired 0359T–0374T code set — while the current quarterly manuals and live fee schedule sit inside GAMMIS (mmis.georgia.gov), which refuses automated clients outright. [2]
- **Diagnostic tools required**: The posted manual asks for one tool, not two: “diagnosis should be made and confirmed in early childhood using one of the following tools: Autism Diagnostic Observation Schedule (ADOS), Autism Diagnostic Interview (ADI), the Diagnostic Interview for Social, Communication Disorders (DISCO), and/or other known evidence based tools.” For the behavioral assessment it adds that “the QHCP must use valid and reliable evaluation tools that conform to industry standards (such as the ADOS).” Three conditions must be ruled out as causal: primary hearing deficits, primary speech disorder, and heavy metal poisoning. Treat the one-tool floor as a floor only — the two-instrument requirement families actually face (one clinician-administered tool plus one caregiver tool) comes from the CMOs, and school psychoeducational assessments are not acceptable as a diagnostic evaluation on any of them. Sourcing caveat: the ASD manual publicly posted on medicaid.georgia.gov is the January 2018 version and is known to be stale — its Appendix A still prices the retired 0359T–0374T code set — while the current quarterly manuals and live fee schedule sit inside GAMMIS (mmis.georgia.gov), which refuses automated clients outright. [2][5][4]
  - Ask the plan: The current ASD manual inside GAMMIS for the live instrument list; Peach State GA.CP.BH.504 and CareSource MCD-MM-0212 publish the operative two-tool requirement openly.
- **Referral required?**: Two separate gates, and only one of them is what intake usually means by “referral.” Clinically, ASD services “must be recommended by a licensed physician or other licensed practitioner of the healing arts acting within their scope of practice under state law” per 42 CFR 440.130(c), and “all ABS PAs must be requested by the enrolled QHCP” — a licensed physician, psychologist, BCBA-D or BCBA; BCaBAs and RBTs cannot serve as the QHCP. Administratively, the ordering, prescribing or referring practitioner’s NPI must appear on the claim — on the CMS-1500 “enter qualifiers to indicate if the claim has an ordering, referring, or prescribing provider to the left of the dotted line in box 17 (Ordering = DK; Referring = DN or Supervising = DQ)” — and that practitioner must be enrolled in Georgia Medicaid, or the claim denies. The treatment PA package also carries the IFSP/IEP where applicable. [10][2]
- **Telehealth**: Georgia publishes a real telehealth benefit for ABS, and the best current source for it is not the ASD manual — it is the DCH Part II Telehealth Guidance (version date 10/1/2025), which carries its own ASD section. “Practitioners of ASD services can use telehealth to assess, diagnose and provide therapies to patients,” provided they hold a current Georgia medical or psychology licence or a valid ABA certification; Georgia Medicaid enrols BCBAs as QHCPs for this purpose. The guidance publishes a current Category I code table for telehealth ABS — 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T and 0373T, each in 15-minute units with the GT modifier and the U1–U5 practitioner-level modifier (U1 physician/psychiatrist, U2 psychologist or BCBA-D, U3 BCBA, U4 BCaBA or master’s-level behavior analyst, U5 RBT). On the claim, “the GT modifier is required as applicable, and/or the use of either POS 02 or POS 10,” where POS 02 is telehealth outside the patient’s home and POS 10 is telehealth in the patient’s home; CPT modifier 93 may be appended for audio-only services where appropriate. Prior authorization applies to telehealth ABS exactly as it does in person. Worth noting for the code-set question generally: this DCH document carries the Category I 97151–97158 set, while the posted January 2018 ASD manual still prices 0359T–0374T. [10]
  - Ask the plan: Whether Georgia still limits telehealth billing to a rendering provider located in Georgia or within 50 miles of the state line — CareSource MCD-MM-0212 states that rule and attributes it to this guidance, but the 10/1/2025 version does not contain it. Confirm in GAMMIS (mmis.georgia.gov) or with DCH before relying on either reading.
- **Prior-auth decision time**: Federal law sets the ceiling, and Georgia's CMOs publish a faster clock. For fee-for-service members, the state must decide a standard prior authorization "in no case later than 7 calendar days after receiving the request" (beginning January 1, 2026). It may add up to 14 calendar days if the family or provider asks or the state needs more information. Expedited requests are due "no later than 72 hours." CMO members fall under the federal managed-care cap of 7 calendar days from receipt (42 CFR 438.210(d)), plus Georgia's prior-authorization law. That law applies to DCH's CMO contracts (O.C.G.A. 33-46-30): notice "within 7 calendar days of obtaining all necessary information," 72 hours for urgent, and "automatic authorization" when a deadline is missed. All three CMOs' current manuals print a stricter standard: three business days for a standard request and 24 hours for an expedited one. ABS is authorized "in six (6) month increments," with the assessment and treatment PAs requested separately. The posted ASD manual sets no lead time for reauthorization. [12][13][14][15][16][17][2]
- **Other insurance (who pays first)**: Georgia Medicaid pays last. DCH's Part I manual (version date July 1, 2026): "other available third-party resources must be exhausted before Medicaid/PeachCare for Kids pays." Providers must file "with the appropriate primary health plan(s) prior to filing with Medicaid" and list the other insurers and their payments on the claim. Medicaid pays only the gap up to its own maximum allowable. Get Medicaid's own PA even when Medicaid is secondary. DCH's Part I manual: "Regardless of whether or not the primary plan has made any payment toward a service, when billing the secondary claim to Medicaid, you must follow the Medicaid policies and procedures for that particular Category of Service, including adherence to all policies/guidelines for pre- certification and pre-authorizations of services." A claim the primary plan denied because the provider did not follow its rules is not paid: DCH "will not reimburse the provider submitted charges denied by the primary plan because of the provider's failure to follow the primary plan's rules." So get the commercial PA as well. A service the primary plan does not cover, or where its annual or lifetime limits are exhausted, "is reimbursable up to the Medicaid/PeachCare for Kids maximum allowable amount." EPSDT exception: "A provider is not required to exhaust other health plan benefits with respect to claims for preventive and pediatric services including health check (also known as EPSDT)." The manual does not say whether ABS claims fall under it. TRICARE pays only after other coverage "except in the case of a plan administered under title XIX" (Medicaid), so TRICARE goes before Georgia Medicaid. CHAMPVA is the reverse: "If you are eligible under Medicaid, CHAMPVA will pay first." [18][19][20][21][22]
  - Ask the plan: The member's CMO or the GAMMIS TPL unit (678-564-1162, option 3) — ask whether an ABS claim for a child under 21 is paid under the EPSDT exception without the primary EOB.

## Delivery and billing rules

Coverage decides whether Georgia Medicaid pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Supervision**: Georgia runs a caseload cap, not a percentage floor. Under the DCH manual a physician, psychiatrist, BCBA-D or BCBA — the enrolled Qualified Health Care Provider (QHCP) — may supervise up to six certified BCaBAs and RBTs at any point in time, and the attestation appendix caps a licensed non-BCBA supervisor (a physician, say) at three practitioners. “Supervision” is defined as direct clinical review for training or teaching and does NOT require the supervisor to be present at the work site. Both supervisor and supervisee must keep a contemporaneous record of the date, duration, type and a brief summary of each supervision session, producible on audit; discrepancies make the associated claims subject to recoupment. A BCaBA must be supervised by a BCBA/BCBA-D but may supervise RBTs; an RBT can never be the QHCP. Every supervised direct-care professional must attest to one year of ASD experience, and the Attestation must be resubmitted within two weeks of any staffing change. [2]
- **Session-note signature**: The person who wrote the note signs it — the manual imposes no supervising-analyst co-signature. Records must contain “progress notes that are legible, detailed, complete, signed and dated,” and every signature must be “legible, original and belong to the person creating the signature”; if illegible the name must also be printed. All signatures must be dated the actual date signed, rubber-stamp signatures are not accepted, and electronic signatures are accepted only in the circumstances set out in Part I § 106. Records must be documented in ‘real time’ and not back-dated; corrections take a single strike-through plus the corrector’s initials and date, never whiteout. [2]
- **Place of service**: Georgia prices by setting rather than restricting it: every ABS line carries a service-location modifier — U6 in-clinic, U7 out-of-clinic (paid at a materially higher rate), GT telemedicine — alongside the practitioner-level modifier. The posted manual sets no school, community or group-home rule of its own; the school-setting requirements an intake team will actually meet are in the CMO policies (Peach State requires a separate school plan for every educational setting). [2]
  - Ask the plan: For school and group-home delivery specifically: the member’s CMO policy, and the current ASD manual inside GAMMIS.
- **Bill as provider**: The claim goes out under the enrolled QHCP and/or the facility. BCaBAs and RBTs “are not enrolled directly by the Division as providers because they are not independent practitioners” — their services are claimed under the enrolled provider identification number of the supervising QHCP and/or the facility, and if the payee is a facility the QHCP must attest under the facility Medicaid ID and list all supervisees. Practitioner level rides as a modifier: U1 physician/psychiatrist, U2 psychologist or BCBA-D, U3 BCBA, U4 BCaBA or master’s-level analyst with a year of ASD experience, U5 RBT with a year of ASD experience — plus the setting modifier (U6/U7/GT). Separately, the ordering/prescribing/referring practitioner’s NPI must appear on the claim (CMS-1500 box 17, qualifier DK ordering, DN referring, DQ supervising) and that practitioner must be Georgia-Medicaid-enrolled or the claim is denied. [2]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: GAMMIS (mmis.georgia.gov) provider manual + fee schedule for the current ASD policy, or the member’s CMO policy — CareSource MCD-MM-0212 and Peach State GA.CP.BH.504 are the ones published openly.

## What intake should collect for Georgia Medicaid

- **Medicaid ID + CMO:** Which plan the child is on (CareSource, Peach State, Amerigroup, or FFS) — it decides the whole PA path.
- **Diagnosis report + tools used:** DSM-5 ASD diagnosis, diagnosing provider and credentials, instruments used, and the date (5-year window; 6-month recency for assessments).
- **Katie Beckett status:** For non-Medicaid families: whether they've applied, and a pointer to the online portal if not.
- **IEP / IFSP:** Required in the PA package when applicable; also flags school-setting rules.
- **Preferred setting & availability:** Home vs. center affects modifiers and rates; school attendance affects allowable weekly hours.
- **Other services in place:** Speech, OT, PT — the Plan of Care must document coordination.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Georgia Medicaid ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00100
- **Payer ID (Availity):** 77034 — QA re-check (2026-07-23): the cited Availity list carries an "As of 08/08/2012" footer — 77034=GAMEDICAID is confirmed present in that snapshot, but downgraded from verified to inferred pending reconfirmation against a current Availity export (same treatment already applied to aetna-florida for the identical staleness finding).
- **Payer ID (Change Healthcare / Optum):** GAMCD — Resolved this pass: Change Healthcare's Real-Time Eligibility (270/271) list shows "Georgia Medicaid GAMCD GA" — GAMCD is the ELIGIBILITY payer ID. The two previously-conflicting candidates are transaction- or vendor-specific, not eligibility IDs: 12K05 is Change Healthcare's INSTITUTIONAL-claims (837I) payer ID for "Medicaid of Georgia" (Optum institutional list), and SKGA0 is a DIFFERENT clearinghouse's (claim.md) primary code for GA Medicaid, not an Optum/Change Healthcare value. Professional-claims (837P) also route on GAMCD.
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required | 32 units/day per day | in-clinic (U6 modifier), out-of-clinic / home / community (U7 modifier, higher rate), telehealth (POS 02 patient not at home, or POS 10 patient at home) | Yes — GT modifier, POS 02 or 10 per DCH's Oct 2025 telehealth guidance §605/§614. | U1, U2, U3, U4, U5, U6, U7, GT, 93 (audio-only) |
| 97152 | Yes | Required | 16 units/day per day | in-clinic (U6 modifier), out-of-clinic / home / community (U7 modifier, higher rate), telehealth (POS 02 patient not at home, or POS 10 patient at home) | Yes — GT modifier, POS 02 or 10 per DCH's Oct 2025 telehealth guidance §605/§614. | U1, U2, U3, U4, U5, U6, U7, GT, 93 (audio-only) |
| 97153 | Yes | Required | 32 units/day per day | in-clinic (U6 modifier), out-of-clinic / home / community (U7 modifier, higher rate), telehealth (POS 02 patient not at home, or POS 10 patient at home) | Yes — GT modifier, POS 02 or 10 per DCH's Oct 2025 telehealth guidance §605/§614. | U1, U2, U3, U4, U5, U6, U7, GT, 93 (audio-only) |
| 97154 | Yes | Required | 18 units/day per day | in-clinic (U6 modifier), out-of-clinic / home / community (U7 modifier, higher rate), telehealth (POS 02 patient not at home, or POS 10 patient at home) | Yes — GT modifier, POS 02 or 10 per DCH's Oct 2025 telehealth guidance §605/§614. | U1, U2, U3, U4, U5, U6, U7, GT, 93 (audio-only) |
| 97155 | Yes | Required | 24 units/day per day | in-clinic (U6 modifier), out-of-clinic / home / community (U7 modifier, higher rate), telehealth (POS 02 patient not at home, or POS 10 patient at home) | Yes — GT modifier, POS 02 or 10 per DCH's Oct 2025 telehealth guidance §605/§614. | U1, U2, U3, U4, U5, U6, U7, GT, 93 (audio-only) |
| 97156 | Yes | Required | 16 units/day per day | in-clinic (U6 modifier), out-of-clinic / home / community (U7 modifier, higher rate), telehealth (POS 02 patient not at home, or POS 10 patient at home) | Yes — GT modifier, POS 02 or 10 per DCH's Oct 2025 telehealth guidance §605/§614. | U1, U2, U3, U4, U5, U6, U7, GT, 93 (audio-only) |
| 97157 | Yes | Required | 16 units/day per day | in-clinic (U6 modifier), out-of-clinic / home / community (U7 modifier, higher rate), telehealth (POS 02 patient not at home, or POS 10 patient at home) | Yes — GT modifier, POS 02 or 10 per DCH's Oct 2025 telehealth guidance §605/§614. | U1, U2, U3, U4, U5, U6, U7, GT, 93 (audio-only) |
| 97158 | Yes | Required | 16 units/day per day | in-clinic (U6 modifier), out-of-clinic / home / community (U7 modifier, higher rate), telehealth (POS 02 patient not at home, or POS 10 patient at home) | Yes — GT modifier, POS 02 or 10 per DCH's Oct 2025 telehealth guidance §605/§614. | U1, U2, U3, U4, U5, U6, U7, GT, 93 (audio-only) |
| 0362T | Yes | Required | 16 units/day per day | in-clinic (U6 modifier), out-of-clinic / home / community (U7 modifier, higher rate), telehealth (POS 02 patient not at home, or POS 10 patient at home) | Yes — GT modifier, POS 02 or 10 per DCH's Oct 2025 telehealth guidance §605/§614. | U1, U2, U3, U4, U5, U6, U7, GT, 93 (audio-only) |
| 0373T | Yes | Required | 32 units/day per day | in-clinic (U6 modifier), out-of-clinic / home / community (U7 modifier, higher rate), telehealth (POS 02 patient not at home, or POS 10 patient at home) | Yes — GT modifier, POS 02 or 10 per DCH's Oct 2025 telehealth guidance §605/§614. | U1, U2, U3, U4, U5, U6, U7, GT, 93 (audio-only) |

Code notes:

- **97151:** Billed as a family with 97152 in GAMMIS PA requests — entering one code sends both for authorization. Comprehensive assessment generally capped at 8 hrs per 6-month period.
- **97152:** Billed as a family with 97151 in GAMMIS PA requests.
- **97153:** Billed as a family with 97154/97155 in GAMMIS PA requests.
- **97154:** Billed as a family with 97153/97155 in GAMMIS PA requests.
- **97155:** Billed as a family with 97153/97154 in GAMMIS PA requests.
- **0373T:** Extra-technician / intensifying protocol; DCH-aligned CMO policies generally require a titration plan back toward 97153 and a BCBA onsite and immediately available.

### Contacts

- **Provider services phone:** 800-766-4456
- **Hours:** 7 a.m.–7 p.m. ET, Monday–Friday (except state holidays); GAMMIS web portal available 24/7
- **Portal:** [GAMMIS Web Portal](https://www.mmis.georgia.gov)
- **Fax:** 404-656-8366 (DCH ABS Enrollment — ASD/ABS provider attestation submissions specifically, not general provider services)

Questions to ask on a verification call:

- What Change Healthcare payer ID should we use for GA Medicaid eligibility checks — pVerify lists two conflicting candidates (SKGA0 and 12K05)?
- Can you confirm 77034 is still the correct Availity payer ID for GA Medicaid — our cited source is a 2012 snapshot?
- Does eligibility checking return real-time or batch-only 271 responses?
- Where in the 271 response does CMO/managed-care enrollment appear (loop/segment), and what carrier codes map to which CMO?
- Is CMO eligibility span reported monthly, daily, or in real time?
- Is the ABA cost share a copay or coinsurance, and is it charged per visit or per day?
- Which service-type-code bucket does GAMMIS return ABA benefit detail under, and does the deductible or out-of-pocket max apply to it?

### VOB data sources

- https://www.mmis.georgia.gov/portal/PubAccess.EDI/Companion%20Guides/tabId/45/Default.aspx (accessed 2026-07-23)
- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://business.optum.com/content/dam/o4-dam/resources/pdfs/white-papers/real-time-eligibility-payer-list.pdf (accessed 2026-07-23)
- https://www.optum.com/content/dam/o4-dam/resources/pdfs/guides/institutional-claims-payer-list.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.mmis.georgia.gov/portal/portals/0/staticcontent/public/all/notices/autism%20spectrum%20disorder%202023%20(002)%2020230209200139.pdf (accessed 2026-07-23; source document older than 18 months)
- https://setrc.us/wp-content/uploads/2025/11/Telehealth-Guidance-Q4-October-2025.pdf (accessed 2026-07-23)
- https://medicaid.georgia.gov/document/publication/asd-policy-manual/download (accessed 2026-07-23; source document older than 18 months)

## Common questions

### Does Georgia Medicaid cover ABA therapy?

Yes — for members under age 21 with a documented DSM-5 ASD diagnosis, under EPSDT, effective since January 2018. All services require prior authorization.

### Can families who earn too much for Medicaid still get ABA covered?

Often, yes — through the Katie Beckett (TEFRA) deeming waiver, which ignores family income and qualifies the child based on level of care. Approval confers full Medicaid eligibility, including the ABA benefit.

### How long do Georgia Medicaid ABA authorizations last?

Treatment authorizations are issued in 6-month increments, with reauthorization requiring a recent assessment (within 2 months), documented progress, and updated goals.

## Primary sources

1. [GA DCH — Autism Spectrum Disorder program](https://medicaid.georgia.gov/programs/all-programs/autism-spectrum-disorder)
2. [GA DCH — Part II ASD Policy Manual](https://medicaid.georgia.gov/document/publication/asd-policy-manual/download)
3. [GA DCH — Katie Beckett / TEFRA](https://medicaid.georgia.gov/programs/all-programs/tefrakatie-beckett)
4. [CareSource GA MCD-MM-0212 (ABA policy)](https://www.caresource.com/documents/medicaid-ga-policy-medical-mm-0212-20250101)
5. [Peach State GA.CP.BH.504 (ASD services)](https://www.pshpgeorgia.com/content/dam/centene/peachstate/policies/clinical-policies/GA.CP.BH.504.pdf)
6. [Georgia HB 412 (2022) — O.C.G.A. Title 43, Ch. 7A](https://gov.georgia.gov/document/2022-signed-legislation/hb-412/download)
7. [Ga. Comp. R. & Regs. 75-5-.01 (licensure by certification)](https://www.law.cornell.edu/regulations/georgia/Ga-Comp-R-Regs-R-75-5-.01)
8. [GA licensure application deadlines (secondary source)](https://www.appliedbehavioranalysisedu.org/georgia/)
9. [BACB RBT Handbook](https://www.bacb.com/rbt-handbook)
10. [GA DCH — Part II Policies and Procedures for Telehealth Guidance, version date 10/1/2025 (hosted copy — the medicaid.georgia.gov download link serves a 2020 file and GAMMIS blocks automated access)](https://setrc.us/wp-content/uploads/2025/11/Telehealth-Guidance-Q4-October-2025.pdf)
11. [Georgia Medicaid — Georgia Families Latest News (updated 4/23/2026)](https://medicaid.georgia.gov/programs/all-programs/georgia-families/georgia-families-latest-news)
12. [42 CFR 440.230(e) — Medicaid fee-for-service prior authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-440.230)
13. [42 CFR 438.210(d) — MCO authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
14. [CareSource Georgia Medicaid Provider Manual (GA-MED-P-2890751a, July 2026)](https://www.caresource.com/documents/ga-provider-manual.pdf)
15. [Peach State Health Plan Provider Manual (April 2026)](https://www.pshpgeorgia.com/content/dam/centene/peachstate/pdfs/GA-INT-11666%20Provider%20Handbook%20Update%202026%20FINAL%202_R.pdf)
16. [Amerigroup Georgia Medicaid Provider Manual (GA-AGP-CD-PM-003925-26)](https://provider.amerigroup.com/docs/gpp/GA_CAID_ProviderManual.pdf)
17. [Georgia SB 80 (2021) — O.C.G.A. 33-46-26, -27, -29, -30 (Ensuring Transparency in Prior Authorization Act)](https://gov.georgia.gov/document/2021-signed-legislation/sb-80/download)
18. [GA DCH — Part I Policies and Procedures for Medicaid/PeachCare for Kids (version date July 1, 2026), 104.3 and 303 (GAMMIS copy retrieved via web.archive.org)](https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/HANDBOOKS/Part%201%20Policies%20and%20Procedures%20for%20Medicaid%20PeachCare%20for%20Kids%20Q3%20July%202026%2020260706155614.pdf)
19. [42 CFR 433.139 — Medicaid third-party liability, payment of claims (eCFR)](https://www.ecfr.gov/current/title-42/section-433.139)
20. [42 U.S.C. 1396a(a)(25) — Medicaid third-party liability](https://www.govinfo.gov/content/pkg/USCODE-2023-title42/html/USCODE-2023-title42-chap7-subchapXIX-sec1396a.htm)
21. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage, Medicaid excepted](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
22. [CHAMPVA Guidebook (updated Jan. 1, 2025) — Other Health Insurance](https://www.va.gov/COMMUNITYCARE/docs/pubfiles/programguides/CHAMPVA-Guide.pdf)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.