With funding from the federal government made available under the Affordable Care Act ( ACA ), the Georgia Medicaid program is reimbursing eligible physicians at a higher rate equal to Medicare payment rates for services represented by Current Procedural Terminology ( CPT ) codes 99201 through 99499 and vaccine administration codes. The rate increase, effective January 1, 2013, will apply to Georgia Medicaid and the state s three care management organizations ( CMOS ) that provide services through the Georgia Families program. The enhanced rates do not apply to the PeachCare for Kids program.
In order to qualify for these rates, physicians or providers under the personal supervision of physicians who meet the eligibility requirements as defined in the ACA Final Rule, must file an attestation form within 90 days of May 1, 2013. These providers must self-attest to their specialty designations in family medicine, general internal medicine, pediatric medicine, or subspecialties recognized by the American Board of Medical Specialties, American Board of Physician Specialties, or the American Osteopathic Association and meet one of the following criteria:
- Retain board certification in the specialty or subspecialty
- Furnish evaluation and management ( E&M ) and/or vaccine administration services that equal at least 60% of the Medicaid codes billed during the most recent calendar year
Visit the Georgia Medicaid web portal or call (800) 766-4456 to obtain the required attestation form. For assistance with completing the attestation forms or calculating achievement of the 60% threshold for non-board-certified physicians, contact the experts listed below at PYA, (800) 270-9629.
