Georgia Medicaid Fee Schedule
Georgia Medicaid pays $82.05 on its ordinary schedule for an established-patient office visit (99213), and $82.05 to $83.82 across its rate types. The ordinary rate is the 14th-highest of 45 Medicaid programs.
- Schedule as of
- July 2026
- Codes priced
- 7,107
- 99213 vs. median
- 115% of median
Current Georgia Medicaid rates for common codes
Each amount is the unmodified non-facility rate in the July 2026 schedule. Where a code appears under more than one rate type, it is the state's ordinary statewide rate when its rules name one, and otherwise the median across rate types. Modifier-specific and facility-only rows are listed separately under the service.
| Code | Service | Non-facility rate |
|---|---|---|
| 99213 | Office visit, established patient (low complexity)$82.05 to $83.82 across 3 rate types
1 rate type
| $82.05Ordinary statewide rateIn effect since Jul 1, 202514th-highest of 45 · 115% of median |
| 99214 | Office visit, established patient (moderate complexity)$115.71 to $118.20 across 3 rate types
1 rate type
| $115.71Ordinary statewide rateIn effect since Jul 1, 202514th-highest of 45 · 114% of median |
| 99203 | Office visit, new patient (low complexity)$76.53 to $109.35 across 3 rate types
| $76.53Ordinary statewide rateIn effect since Jul 1, 202111th-lowest of 45 · 86% of median |
| 99204 | Office visit, new patient (moderate complexity)$110.51 to $167.09 across 2 rate types
| $110.51Ordinary statewide rateIn effect since Jul 1, 20218th-lowest of 45 · 82% of median |
| 99285 | Emergency department visit, high severity with threat to function$132.41 to $177.20 across 3 rate types
| $132.41Ordinary statewide rateIn effect since Jul 1, 202117th-lowest of 42 · 95% of median |
Dot: Georgia. Tick: median across state programs. Line: lowest to highest state. Base fee-for-service rates; supplemental payments some states add are not included.
Georgia is 14th-highest of 45 for 99213. See where all 7,107 Georgia Medicaid codes rank.
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Compare any other code across state programs. The free view shows a few states per code; Georgia's full schedule is in the complete dataset.
What to know about the Georgia Medicaid fee schedule
- Georgia still pays qualifying primary care physicians and OB/GYNs 100% of the CY 2014 ACA enhanced primary care rates. SPA 25-0003 (CMS)
- Codes 99213 and 99214 rose to 90% of 2024 Medicare in July 2024, then another 2.154% in July 2025. HB 916, FY 2025 budget (conference version) SPA 24-0006 (CMS) HB 68, FY 2026 budget (conference version) SPA 25-0003 (CMS)
- Delivery codes 59400, 59510, 59610 and 59618 have paid the 2024 Medicare rate since July 1, 2024. HB 916, FY 2025 budget (conference version) SPA 24-0006 (CMS)
- Physicians affiliated with a governmental teaching hospital can get directed CMO payments up to commercial-equivalent rates. DCH State Directed Payment Programs
Georgia Medicaid fee schedule FAQ
Does a listed code mean the service is covered by Georgia Medicaid?
No. A listed Georgia Medicaid fee is not a coverage, authorization, or payment guarantee. Coverage, prior approval and billing limits are set in the Georgia Medicaid provider manuals for physician services.
Does this Georgia rate apply to Medicaid managed-care plans?
Georgia has delivered much of its Medicaid program through Georgia Families, a managed care program started in 2006 that contracts with private Care Management Organizations (Amerigroup, CareSource and Peach State Health Plan); DCH reported 1,587,559 Medicaid CMO members in July 2025. CMO payment rates are set in each CMO's provider contracts and are not on this schedule. The fee-for-service rates apply when Georgia Medicaid pays a claim directly.
Why might my actual payment differ from the displayed rate?
These are the July 2026 Georgia Medicaid rates. A claim can pay a different amount because of the date of service, modifier, place of service, units billed, provider enrollment or taxonomy, bundling with another service, coverage policy, prior authorization, and claim edits.
Why is there no published rate for this code?
Georgia Medicaid does not publish a fixed amount for every code. A code may also be bundled into another service or priced on a different Georgia Medicaid schedule. A missing rate does not mean the service is noncovered or pays $0.
Where can I find other Georgia Medicaid fee schedules?
Georgia Medicaid publishes separate fee schedules by provider type alongside the Georgia Physician Schedule of Maximum Allowable Payments, and its provider manual sets the coverage and billing rules.
Does Georgia still pay the ACA enhanced primary care rate?
Yes. Georgia's state plan keeps paying family medicine, pediatric and internal medicine physicians 'as if the requirements of 42 CFR 447.400 remain in effect', at 100% of the CY 2014 rates. Physicians qualify by board certification or by having 60% of paid Medicaid procedures in qualifying E/M and vaccine codes. The rates extend to OB/GYNs and to supervised PAs, NPs and nurse midwives, but not to FQHCs, RHCs, health departments or encounter-rate settings.
What did HB916 change for Georgia physician rates?
Funded by the FY 2025 budget (HB 916), CMS approved SPA GA-24-0006 on October 7, 2024, effective July 1, 2024. It raised 99213 and 99214 to 90% of the 2024 Medicare rate and delivery codes 59400, 59510, 59610 and 59618 to the 2024 Medicare rate. Because only two E/M codes moved, 99215 can pay less than 99214 on Georgia's base schedule.
Did Georgia raise physician rates again for FY 2026?
Only for two codes. Under HB 68, the FY 2026 budget, DCH increased 99213 and 99214 by 2.154% for dates of service from July 1, 2025, and CMS approved the change as SPA GA-25-0003 on September 4, 2025. Other physician codes did not change under that amendment.
Do Georgia CMOs have to pay the Medicaid fee-for-service rate?
No published rule requires it. About 69% of Georgia Medicaid enrollees were in Georgia Families care management organizations in July 2024 (KFF), and each CMO sets physician rates in its own provider contracts. The state directs extra CMO payments only through specific programs, such as the Physician Directed Payment Program.
Can Georgia physicians be paid above the fee schedule?
Yes, in two programs. Practitioners affiliated with a governmental teaching hospital can join the Physician Directed Payment Program, which pays uniform increases through the CMOs up to commercial-equivalent rates (about $239 million estimated for SFY 2026), funded by intergovernmental transfers. Since October 2021, primary care physicians on the enhanced rate can also get Physician Upper Payment Limit supplemental payments.
How does Georgia announce Medicaid rate changes?
Under 42 CFR 447.205, DCH publishes a public notice of each significant proposed payment change, naming the funding bill, the codes affected and the state and federal cost, with a comment period before the Board of Community Health votes. The change then goes to CMS as a state plan amendment, and can apply to dates of service before CMS approves it.
Neighboring and high-enrollment Medicaid fee schedules
States bordering Georgia first, then the largest programs.