Georgia’s Medicaid program released updated fee schedules on July 1, 2026. These rates cover State Fiscal Year (SFY) 2027, which runs from July 1, 2026, through June 30, 2027.
The new schedules include physician services, durable medical equipment (DME), lab work, anesthesia, and more.
This guide breaks down what changed, where to find official rate files, and how these updates affect both providers and patients.
Quick Summary
- Georgia’s core Medicaid fee schedules updated July 1, 2026, for SFY 2027
- Primary care physicians received a 5% rate increase in the final FY 2027 budget
- Nursing home per diem rates grew 0% at the base level, with quality and insurance-cost adjustments
- Some managed care organizations (MCOs) cut therapy and ABA rates, then partly reversed the cuts
- Providers must meet a group enrollment deadline in GAMMIS by July 1, 2026
- Patients wondering if they qualify for coverage can use the Medicaid eligibility calculator to check their status in minutes
What Is a Medicaid Fee Schedule?
A Medicaid fee schedule is a list of prices. It tells doctors, labs, and other providers how much Medicaid will pay for each service. States update these lists every year, or sometimes more often.
Georgia’s Department of Community Health (DCH) manages the state’s schedule through its Medicaid Management Information System, known as MMIS.
Where to Find the Official 2026-2027 Georgia Medicaid Fee Schedule
Georgia does not publish one single summary sheet with every rate. Instead, providers download separate files by service type.
As of August 2026, the MMIS portal lists 61 fee schedule files, with the newest batch released July 1, 2026.
Georgia MMIS Fee Schedules Portal
This is the main source for physician, DME, lab, anesthesia, outpatient, and drug administration rates. Files are posted in both Excel and PDF formats. You can access it directly at the Georgia MMIS Fee Schedules page.
Georgia DCH Nursing Home Reimbursement Rates
Nursing home rates live on a separate page. It includes Provider Reimbursement Rate Sheets and billing rate letters for SFY 2027, found on the DCH nursing home reimbursement rates page.
CMS Value-Based Payment Approval
The Centers for Medicare & Medicaid Services (CMS) approved Georgia’s value-based payment plan for inpatient and outpatient hospital services. This approval covers the rating period from July 1, 2025, through June 30, 2026, and extends into SFY 2027 planning.
Georgia Medicaid Fee Schedule Updates by Service Type (SFY 2027)
Each service category has its own updated file, effective July 1, 2026. Here is a summary of what changed.
| Service Type | Effective Date | Format | Notes |
|---|---|---|---|
| Physician services | July 1, 2026 | Excel & PDF | Enhanced rate crosswalk shows standard vs. enhanced payments |
| DME & orthotics/prosthetics | July 1, 2026 | Excel & PDF | Full line-item rates in downloadable files |
| Laboratory services | July 1, 2026 | Max allowable payment schedule updated | Independent labs move to 80% of Medicare Lab Cahaba fee schedule (SPA, effective June 12, 2026) |
| Anesthesia | July 1, 2026 | CPT & base units updated | — |
| Outpatient / site-of-service | July 1, 2026 | Max allowable payment by site | — |
| Provider-administered drugs | July 1, 2026 | Excel & PDF | Includes COVID-19 monoclonal antibodies and vaccines |
Georgia does not publish exact dollar amounts per CPT code in a summary table. Providers must download the full Excel or PDF files for line-item rates by procedure code.
Nursing Home Per Diem Rates for SFY 2027
Nursing home rates took effect July 1, 2026. The base growth factor is 0% this year. However, facilities may still see rate changes from two other factors:
- Quality incentive payments, tied to performance measures
- Audited 2024 general liability and professional liability insurance costs, which get folded into the rate calculation
DCH has posted a revised Billing Rate Letter and updated Provider Reimbursement Rate Sheets (R-32) for facilities to download. Some rate sheets, marked effective April 1, 2026, were revised ahead of the July update.
Provider Rate Increases in the FY 2027 Budget
Georgia’s final FY 2027 state budget includes targeted increases for specific provider groups. These are not across-the-board increases. They apply only to the categories listed below.
- Primary care physicians: 5% rate increase, a compromise between earlier House and Senate proposals
- Autism services: Parity-level increases, doubled compared to earlier draft proposals
- Nursing homes, air ambulances, and I/DD facilities: Increases agreed on in the final budget
- Rural obstetric care: The newborn delivery add-on rose from $2,000 to $3,000, while state funding for the Rural OB Directed Payment Program was reduced
Families who depend on these services, especially in maternal and disability care, may also want to review current Medicaid eligibility rules, since coverage access and provider payment rates work together to determine care availability.
Managed Care Organization (MCO) Rate Adjustments
Most Georgia Medicaid members get coverage through managed care organizations, not the state directly. Two MCOs made notable rate changes in 2026.
- CareSource and Peach State Health Plan notified providers in March and April 2026 of temporary cuts to 80% of the Medicaid fee schedule for certain therapy and ABA services, effective May 2026.
- Partial rescission: In July 2026, CareSource reversed the 20% cut for select providers in specialties facing documented network adequacy shortages. This rescission was not universal.
- DCH confirmed the rescissions are targeted. They do not apply to every provider or every specialty.
Providers should check directly with each MCO, since managed care rates can differ from the state’s base fee schedule.
Provider Enrollment Fee and Compliance Requirements
Two federal and state requirements affect Georgia Medicaid providers in 2026.
Institutional Provider Application Fee: Federal rule 42 CFR 455.460 sets the calendar year 2026 fee at $750, effective January 1 through December 31, 2026.
Group and Billing Enrollment Enforcement: Starting July 1, 2026, individual provider National Provider Identifiers (NPIs) must be linked to group NPIs inside GAMMIS. Providers who do not comply risk claim denials or payment suspension.
What’s Not Yet Published for 2026-2027
Some information is still incomplete or unavailable as of August 2026:
- Line-item CPT code rates: No aggregated summary table exists; you must download individual MMIS files
- Full statewide percentage increases: Beyond the 5% primary care bump, no confirmed across-the-board increase for all physician services
- MCO-specific provider fee schedules for 2027: CareSource and Peach State publish member copay schedules, but detailed provider reimbursement schedules are not centrally published; check individual MCO contracts
- 2026-2027 dental fee schedule: No dental-specific update found in current MMIS listings; the most recent dental references date to 2025
How to Access the Full Georgia Medicaid Fee Schedule
- Visit the MMIS Fee Schedules page. Go to the Georgia MMIS Fee Schedules portal.
- Download your provider type’s file. Choose Physician, DME, Lab, Anesthesia, or another category, in Excel or PDF.
- Check nursing home rates separately. Use the DCH Reimbursement Rates page for per diem and billing rate letters.
- Cross-reference with your MCO contract. If most of your patients are in managed care, confirm rates directly with CareSource, Peach State, or your assigned MCO.
Patients comparing Georgia’s income and coverage rules to other states can also review Medicaid income limits by state in 2026 or the broader Medicaid Fee Schedule FY 2027 overview for national context.
Key Takeaways
- Georgia’s core Medicaid fee schedules updated July 1, 2026, for SFY 2027
- Targeted increases apply to primary care, autism services, nursing homes, air ambulances, I/DD facilities, and rural OB care
- MCOs made temporary rate cuts to some therapy services, with partial rescissions by mid-2026
- Providers must meet GAMMIS group enrollment rules by July 1, 2026, to avoid payment issues
- Exact CPT-level rates require downloading official Excel or PDF files from MMIS
FAQ
Q: What is the Georgia Medicaid fee schedule for 2026-2027?
A: It’s the official list of payment rates Georgia Medicaid pays providers for services like physician visits, lab work, and DME. The current version took effect July 1, 2026, and covers State Fiscal Year 2027, running through June 30, 2027.
Q: When did the new Georgia Medicaid rates take effect?
A: Most fee schedule updates, including physician, DME, lab, anesthesia, and drug administration rates, took effect July 1, 2026. Nursing home per diem rates also updated on this date, with some rate sheets revised as early as April 2026.
Q: Did Georgia Medicaid increase rates for primary care doctors in 2026?
A: Yes. The final FY 2027 state budget included a 5% rate increase for primary care physicians. This was a compromise between earlier House and Senate budget proposals and applies specifically to primary care, not all physician services.
Q: Where can providers find the official Georgia Medicaid fee schedule?
A: The Georgia MMIS Fee Schedules portal hosts 61 files covering physician, DME, lab, anesthesia, and outpatient rates. Nursing home rates are posted separately on the Georgia DCH reimbursement rates page for providers.
Q: Are Georgia Medicaid managed care rates the same as the state fee schedule?
A: Not always. CareSource and Peach State Health Plan made temporary cuts to some therapy and ABA rates in 2026, later partly reversed. Providers should confirm rates directly with their MCO contract rather than assuming they match the state schedule.
Q: What is the Georgia Medicaid provider enrollment fee for 2026?
A: The institutional provider application fee is $750 for calendar year 2026, set by federal rule 42 CFR 455.460. This fee applies from January 1 through December 31, 2026, for institutional provider applications.
Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official Medicaid.gov, Georgia MMIS, and Georgia DCH guidelines | Last Updated: August 2026
Sources:
- Georgia MMIS Fee Schedules Portal — https://www.mmis.georgia.gov/portal/PubAccess.Provider%20Information/Fee%20Schedules/tabId/19/Default.aspx
- Georgia DCH Nursing Home Reimbursement Rates — https://dch.georgia.gov/providers/provider-types/nursing-home-providers/reimbursement-rates
- CMS Value-Based Payment Approval, Georgia — https://www.medicaid.gov/state-resources/2026-01-12/188196
Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official eligibility, contact your state Medicaid office or visit Medicaid.gov.
