Georgia Medicaid pays healthcare providers based on specific fee schedules that update throughout the year.
The 2026 fee schedule determines how much doctors, hospitals, and pharmacies receive for treating Medicaid patients in Georgia.
Quick Article Summary:
- Georgia Medicaid updates fee schedules quarterly, with major changes on January 1, 2026
- Doctor payments are based on 90% of Medicare rates plus a 2.154% increase
- Hospital rates follow the State Fiscal Year (July 1, 2025 – June 30, 2026)
- You can download official fee schedules from the GAMMIS web portal
- Pharmacy rates use the National Average Drug Acquisition Cost (NADAC) formula
- Provider rate increases include $23 million in new state funding for 2026
Understanding Georgia Medicaid Payment Rates
Georgia does not publish a single fee schedule document. Instead, the Georgia Department of Community Health (DCH) separates payment rates by provider type. Each category has different update schedules and payment methods.
The system uses GAMMIS (Georgia Medicaid Management Information System) to manage all payments. Providers must understand how their specific service type gets paid to bill correctly.
What Is the Maximum Allowable Rate?
The maximum allowable rate is the highest amount Georgia Medicaid will pay for any service. Providers receive the lower amount between what they charge and this maximum rate.
For example, if a doctor bills $100 but the maximum rate is $82, Medicaid pays only $82. This protects the state budget while ensuring fair provider payment.
State Fiscal Year vs Calendar Year
Georgia Medicaid uses two different schedules:
State Fiscal Year (SFY) 2026: July 1, 2025 to June 30, 2026
- Hospital inpatient rates
- Nursing home payments
- Long-term care services
Calendar Year (CY) 2026: January 1, 2026 to December 31, 2026
- Physician services
- Pharmacy rates
- Medical equipment
Understanding which schedule applies helps you find the correct payment rates. If you’re checking whether you qualify for coverage, review the Georgia Medicaid income limits in 2026 first.
2026 Fee Schedule Updates by Provider Type
Georgia Medicaid updated multiple fee schedules for 2026. Each provider category has specific payment rules and update dates.
Physician and Professional Services
Doctor payments updated on January 1, 2026. Georgia bases physician rates on Medicare’s pricing system with state-specific adjustments.
Key Payment Details:
- Rates are 90% of the 2024 Medicare Physician Fee Schedule
- Evaluation codes (99213, 99214) received a 2.154% increase in July 2025
- Telehealth services pay the same as in-person visits when coded correctly
- Updates happen quarterly but January brings the biggest changes
Example Office Visit Payment:
A Level 3 office visit (CPT code 99213) pays approximately $81.82 in 2026. This calculation starts with Medicare’s rate, applies the 90% Georgia factor, then adds the 2.154% increase.
Telehealth appointments must use the modifier “GT” or “95” to receive full payment. Without these modifiers, the claim may be denied or paid at a lower rate.
Pharmacy and Prescription Drug Rates
Pharmacy payments changed on January 1, 2026. The DCH published the “Georgia Estimated Acquisition Cost & Select Specialty Pharmacy Rates” for this year.
Payment Formula:
Georgia Medicaid pays the lowest of the three amounts:
- National Average Drug Acquisition Cost (NADAC) plus dispensing fee
- Wholesale Acquisition Cost (WAC)
- The pharmacy’s usual and customary charge
This ensures the state gets the best price while pharmacies cover their costs. The dispensing fee compensates pharmacies for filling prescriptions and counseling patients.
Specialty medications may have different rate structures. These are listed separately in the specialty pharmacy rate file.
Hospital Payment Rates
Hospital rates follow the State Fiscal Year running from July 1, 2025 to June 30, 2026. Inpatient and outpatient services use different payment systems.
Inpatient Hospital Services:
Paid through DRG (Diagnosis Related Group) methodology. Each diagnosis group has a set payment amount regardless of actual hospital costs. This encourages efficient care.
The SFY 2026 hospital fee schedule was posted in September 2025. Hospitals received their rate updates before the fiscal year started.
Outpatient Hospital Services:
Paid using EAPG (Enhanced Ambulatory Patient Group) or fee-for-service rates. Outpatient procedures, emergency visits, and diagnostic services each have specific codes and rates.
Comparing Georgia’s rates to other states helps providers understand regional differences. Check the Medicaid income limits by state in 2026 to see how programs vary nationwide.
Nursing Homes and Long-Term Care
Nursing home rates are set annually for each State Fiscal Year starting July 1. The FY 2026 budget includes $158.9 million in provider fees to support nursing home payments.
Governor Kemp’s budget proposal specifically targets nursing home rate increases. These increases aim to improve care quality and help facilities recruit staff. Additional rate increases may take effect on July 1, 2026.
Long-term care facilities receive different rates based on:
- Level of care required
- Facility location
- Special services provided
- Quality metrics achieved
Important Changes for 2026
Georgia Medicaid made several significant updates for 2026. These changes affect provider payments and program transparency.
Provider Rate Increases
The FY 2026 budget includes $23 million in state funds for provider rate increases. This money aims to improve access to care by making Medicaid payments more competitive.
Rate increases focus on primary care doctors and specialists who see many Medicaid patients. Higher payments encourage more providers to accept Medicaid coverage.
Federal Transparency Requirements
New federal rules require states to publish Medicaid fee schedules in easy-to-access formats. Georgia must provide machine-readable fee schedule data by July 2026.
This transparency helps:
- Providers verify payment rates before billing
- Patients understand coverage costs
- Researchers compare state Medicaid programs
- Policymakers make informed budget decisions
Medicare Alignment Updates
Many Georgia Medicaid codes link directly to Medicare pricing. When Medicare updates its rates on January 1, 2026, Georgia adjusts matching codes automatically.
This includes:
- Relative Value Units (RVUs) for physician services
- Conversion factors for anesthesia
- Equipment rental rates
- Diagnostic test payments
The Medicaid Fee Schedule 2026 page provides national context for these updates across all states.
How to Access Official Fee Schedules
The complete Georgia Medicaid fee schedules are available through the GAMMIS web portal. These are not simple PDF lists but searchable databases with thousands of billing codes.
Step-by-Step Download Instructions
Step 1: Visit the GAMMIS portal at mmis.georgia.gov
Step 2: Navigate to Provider Information, then click Fee Schedules
Step 3: Look for these specific files:
- “Zipped Fee Schedules – 4th Quarter 2025” (for physician rates effective January 1, 2026)
- “Durable Medical Equipment Services Fee Schedule” (effective January 1, 2026)
- “Georgia Estimated Acquisition Cost & Select Specialty Pharmacy Rates” (effective January 1, 2026)
- “Anesthesia CPT & Base Units” (effective January 1, 2026)
Step 4: Download the files that match your provider type
Step 5: Search for specific CPT or HCPCS codes to find exact payment amounts
Some fee schedule sections require provider login credentials. Public users can access pharmacy lists and general rate information without logging in.
Using the Code Search Function
The GAMMIS search tool lets you enter specific billing codes. Type in a CPT code like “99213” to see the exact 2026 payment rate for that service.
This works for:
- Physician services (CPT codes)
- Medical equipment (HCPCS codes)
- Pharmacy medications (NDC codes)
- Hospital procedures (DRG codes)
Before checking fee schedules, use the Georgia Medicaid calculator to determine if your patients qualify for coverage.
2026 Payment Rate Summary Table
| Service Category | Payment Method | Update Schedule | 2026 Key Reference |
|---|---|---|---|
| Physician Services | 90% of Medicare rates | Quarterly (Jan/Apr/Jul/Oct) | Medicare Jan 2026 updates |
| Pharmacy | NADAC + dispensing fee | Weekly/Quarterly | GMAC List (Jan 1, 2026) |
| Hospital Inpatient | DRG case rates | Annually (July 1) | SFY 2026 rate sheet |
| Anesthesia | Base units × conversion factor + time | Annually (Jan 1) | 2026 conversion factors |
| Medical Equipment | Fee schedule or invoice | Quarterly | Jan 2026 DMEPOS schedule |
This table shows how different provider types receive payment. Understanding your category helps you bill correctly and get paid faster.
Frequently Asked Questions
Q: Where can I find the exact Georgia Medicaid payment rate for a specific service?
Visit the GAMMIS portal at mmis.georgia.gov and download the fee schedule for your provider type. Search for your specific CPT or HCPCS code to see the 2026 rate. Physician codes are in the “Zipped Fee Schedules – 4th Quarter 2025” file.
Q: How often does Georgia Medicaid update fee schedules?
Most fee schedules update quarterly in January, April, July, and October. Major changes happen on January 1 for calendar-year services and July 1 for state fiscal year services like hospital rates.
Q: Does Georgia Medicaid pay the same as Medicare?
No. Georgia Medicaid typically pays 90% of Medicare rates for physician services, then applies state-specific adjustments. Some services have completely different payment structures than Medicare, especially hospital and pharmacy services.
Q: What is the conversion factor for anesthesia services in 2026?
The anesthesia conversion factor is published in the January 2026 fee schedule update. Download the “Anesthesia CPT & Base Units” file from GAMMIS to see the current factor used to calculate time-based payments.
Q: Are telehealth services paid differently than in-person visits?
Georgia Medicaid pays telehealth at the same rate as in-person visits for 2026. You must use modifier “GT” or “95” on your claim to receive full payment for telehealth services.
Q: When will the next provider rate increase take effect?
The FY 2026 budget includes $23 million for rate increases already in effect. Additional nursing home rate increases may start July 1, 2026. Check the GAMMIS portal regularly for announcements about new rate updates.
Last Updated: February, 2026
Official Sources:
- Georgia Department of Community Health: https://dch.georgia.gov
- GAMMIS Web Portal: https://mmis.georgia.gov
