Georgia Medicaid reimbursement rates for State Fiscal Year (SFY) 2027 run from July 1, 2026, through June 30, 2027. There’s no single flat payment rate here. Georgia Medicaid works through multiple fee schedules and reimbursement methodologies, and which one applies depends entirely on the service, the provider type, the procedure code, and the payment system in play.
The official Georgia Medicaid Management Information System (GAMMIS) fee-schedule portal reflects that complexity. Separate schedules exist for physician services, durable medical equipment (DME), laboratory services, anesthesia, orthotic and prosthetic services, outpatient services, provider-administered drugs, and more.
So “What is the Georgia Medicaid reimbursement rate?” isn’t really a question with one answer. The correct rate depends on what’s being billed and which methodology governs it. Providers researching rates for related programs, such as eligibility thresholds, may also want to check Georgia Medicaid income limits for context on who qualifies before diving into payment specifics.
Georgia Medicaid 2027 Rate Period
For providers and billing teams, one date matters most:
SFY 2027: July 1, 2026–June 30, 2027
Always confirm the effective date on the schedule you’re using. A rate pulled from an older quarter — or a previous fiscal year — might not reflect what’s currently being paid on a claim.
Georgia’s GAMMIS fee-schedule system holds quarterly and historical files alongside current ones. Checking the publication date isn’t optional. It’s part of verifying the rate is even correct.
Where to Find the Official Georgia Medicaid Fee Schedule
Most Georgia Medicaid reimbursement rates trace back to the GAMMIS Fee Schedules section. Here’s how the categories break down:
| Service or provider category | Main rate source |
|---|---|
| Physician services | Physician Fee Schedule |
| DME | DME Fee Schedule |
| Laboratory | Lab Maximum Allowable |
| Orthotics and prosthetics | O&P Fee Schedule |
| Anesthesia | Anesthesia CPT & Base Units |
| Outpatient services | Site-of-Service Maximum Allowable |
| Provider-administered drugs | Provider-Administered Drug List |
| Vaccines | Vaccine fee schedule |
| Nursing homes | Georgia DCH reimbursement rate sheets |
| Hospitals | Georgia DCH hospital payment methodology |
| Behavioral health | Applicable provider manuals and schedules |
| Home health | Applicable Georgia Medicaid fee schedule |
Match the schedule to the service. Don’t assume one physician fee schedule — or a general Medicaid schedule — covers every claim you submit.
Georgia Medicaid Fee Schedules by Provider and Service
Physicians, nurse practitioners, physician assistants, dentists, therapists, labs, DME suppliers, hospitals, nursing facilities, behavioral-health providers, home-health agencies, pharmacies. Georgia Medicaid touches all of them, and not through one uniform process.
Some services run on a traditional fee schedule with a maximum allowable amount. Others involve payment systems that are considerably more layered.
Hospital inpatient services, for instance, use a prospective payment methodology built around APR-DRGs. Nursing-home reimbursement, by contrast, relies on facility-specific rate calculations. That gap matters. A simple CPT-rate lookup won’t explain every Medicaid payment made in Georgia.
Georgia Medicaid Physician Reimbursement Rates
Start with the Georgia Medicaid Physician Fee Schedule — it’s the foundation for physician and other professional-service rate research.
Looking up a CPT reimbursement rate? The code alone won’t get you there. Check:
- CPT or HCPCS code
- Applicable modifier
- Provider or service category
- Place of service
- Rate type
- Effective date
- Any authorization or coverage requirements that apply
What About CPT 99213 and 99214?
These office-visit codes get searched constantly, and for good reason — they’re among the most commonly billed. But pull the number from the current physician fee schedule. Not from an old article. Not from another state’s Medicaid rates.
The amount can shift depending on the circumstances under which the service is billed, too. Verify the current GAMMIS schedule and any applicable billing guidance before you submit.
Georgia Medicaid Hospital Reimbursement Rates
Hospital reimbursement doesn’t work like a basic professional fee schedule. Georgia Medicaid uses an Inpatient Prospective Payment System (IPPS) for eligible in-state hospital inpatient services, with claims sorted through an APR-DRG system. Payment shifts based on the diagnosis-related group and factors specific to the hospital itself.
What goes into hospital reimbursement:
- APR-DRG classification
- Statewide base rates
- Hospital-specific adjustments
- Medicaid inpatient utilization
- Indirect medical education
- Peer-group adjustments
- Stop-loss or stop-gain provisions
- Outpatient payment methodologies
Given all that, there’s no such thing as “the” Georgia Medicaid hospital rate.
Georgia Medicaid Nursing Home Rates 2027
Nursing homes follow their own path entirely. The Georgia Department of Community Health publishes SFY 2027 rate sheets, effective July 1, 2026, and nursing-home per diem rates get calculated from cost-report data combined with reimbursement policy.
Facility-specific details drive the number. Skip the statewide estimate — go straight to the current Georgia DCH reimbursement listing and rate sheets for the facility in question.
Dental, DME, Lab, Anesthesia and Other Rates
Georgia Medicaid keeps separate reimbursement tracks for its specialized services.
Dental. Georgia’s FY2027 budget funds an increase for specified dental codes. Still — verify the operational fee schedule directly before relying on a payment figure.
Durable Medical Equipment. The DME fee schedule covers eligible equipment and supplies. HCPCS codes, modifiers, and other billing requirements all factor in.
Laboratory Services. Lab reimbursement runs on maximum-allowable schedules and policy. The correct rate can vary by the specific service and the billing circumstances around it.
Anesthesia. Georgia’s anesthesia schedule includes CPT codes and base-unit figures. Check the units, modifiers, and current conversion rules before billing.
Orthotic and Prosthetic Services. O&P has its own separate fee schedules, downloadable in both PDF and Excel formats.
Georgia Medicaid Managed Care vs Fee-for-Service
Here’s something every Georgia Medicaid provider needs to internalize: a state fee schedule does not guarantee that every member’s health plan pays the same amount.
Under Fee-for-Service (FFS), the applicable Georgia Medicaid methodology and fee schedule set the payment. Under managed care, the member’s managed-care organization and its provider contract call the shots.
Before billing, confirm:
- Which program the member is enrolled in
- Whether the claim falls under FFS or managed care
- Which fee schedule applies
- Whether the managed-care plan runs on separate contracted rates
- Whether authorization is required first
For a broader view of how this compares across state lines, the Medicaid reimbursement rates by state resource is worth a look — useful for providers billing across multiple Medicaid programs.
Georgia Medicaid 2027 Reimbursement Changes
Georgia’s FY2027 budget carries several reimbursement provisions worth knowing:
| Area | FY2027 provision |
|---|---|
| Dental | Increased reimbursement for specified dental codes |
| Psychiatric residential treatment | Funding to increase the rate to $800 per day |
| Primary care | Funding for a 5% increase for two primary-care codes |
| Autism services | Funding to create parity between in-home and in-office reimbursement |
| FQHCs | Increased prospective payment rates |
| Air ambulance | Increased reimbursement |
| Nursing facilities | Changes involving cost-based funding and facility reimbursement |
| ICF/IID | Medicaid rate enhancement for privately owned facilities |
| Nursing-home ventilator care | Increased reimbursement rate |
| Adult heart/lung transplants | SPA-related policy and funding direction |
A budget provision and a published fee-schedule amount are not the same thing. That distinction trips people up constantly.
Before using any announced change for billing, confirm it’s actually been incorporated into the Georgia Medicaid schedule, provider manual, State Plan Amendment, or other operational guidance.
How to Look Up a Georgia Medicaid CPT or HCPCS Rate
- Go to the Georgia Medicaid/GAMMIS fee-schedule area
- Select the correct provider or service category
- Open the current PDF or Excel schedule
- Search for the CPT or HCPCS code
- Check the applicable modifier
- Review the rate type and effective date
- Confirm the place of service and billing requirements
- Check whether prior authorization or documentation is required
- If the member is in managed care, verify the health plan’s contracted payment terms
That process beats searching the code on some unrelated national reimbursement site. Every time.
2026 vs 2027 Georgia Medicaid Reimbursement Rates
No single statewide percentage tells you how reimbursement moved from 2026 to 2027. Changes happen service by service, provider by provider, methodology by methodology.
Some FY2027 provisions zero in on dental services, primary care, autism services, FQHCs, air ambulance, and nursing facilities specifically. Other rates stay put under existing methodologies.
Want a real 2026-to-2027 comparison? Match the same code, the same rate type, the same provider category, and the same effective date window. Anything less isn’t a fair comparison.
Does Georgia Medicaid Reimburse Based on Medicare Rates?
Not automatically, no. Georgia Medicaid doesn’t pay every service at a fixed percentage of Medicare.
Some rates do reference Medicare-based methodologies or similar benchmarks. Others lean on state-specific fee schedules, cost data, prospective payment systems, or entirely different formulas. Use the Georgia Medicaid methodology that actually applies — don’t assume a Medicare payment figure doubles as the Medicaid rate.
FAQs About Georgia Medicaid Reimbursement Rates
What are the Georgia Medicaid reimbursement rates for 2027?
There’s no universal 2027 rate. Rates vary by provider type, service, CPT/HCPCS code, modifier, and reimbursement methodology.
When did Georgia Medicaid 2027 rates become effective?
The SFY 2027 rate period started July 1, 2026, and runs through June 30, 2027.
Where can I find the Georgia Medicaid fee schedule for 2027?
Most current schedules live in the GAMMIS Fee Schedules section. The Georgia Department of Community Health also publishes specialty reimbursement information separately.
How do I look up a Georgia Medicaid CPT code?
Find the correct provider or service fee schedule, search the CPT code, then verify modifiers, rate type, effective date, and billing requirements.
Does Georgia Medicaid have different rates by provider type?
Yes. Physician care, DME, laboratory services, dental care, anesthesia, hospitals, and nursing facilities each run on different schedules and methodologies.
Are Georgia Medicaid rates the same for managed care?
Not necessarily. Managed-care reimbursement often follows the health plan’s provider contract rather than the state’s FFS schedule.
What is the Georgia Medicaid physician fee schedule?
It’s the schedule that sets payment amounts for covered professional services under the applicable Georgia Medicaid payment methodology.
What is the Georgia Medicaid DME fee schedule?
The schedule governing durable medical equipment services and supplies. Verify HCPCS codes, modifiers, and current effective dates before billing.
What are Georgia Medicaid nursing-home reimbursement rates for 2027?
Georgia publishes SFY 2027 nursing-home rate sheets effective July 1, 2026. Rates are facility-specific, so check the current DCH rate sheet directly.
Is the Georgia Medicaid fee schedule updated quarterly?
GAMMIS holds quarterly and historical fee-schedule files. Always use the schedule current to your date of service.
Where can providers download Georgia Medicaid rates in Excel?
Physician, DME, and O&P schedules, among others, are available in Excel format through GAMMIS.
What is the difference between a Medicaid reimbursement rate and a patient cost?
A reimbursement rate pays the provider. It has nothing to do with what a Medicaid member personally pays for a covered service — those are two separate numbers entirely.
Conclusion
At the end of the day, Georgia Medicaid reimbursement isn’t a number you memorize — it’s a lookup you perform, every time, for every claim. Nail down the service, the code, the provider category, the modifier, and the effective date, then check it against the current GAMMIS schedule or DCH source before you bill. That habit will save you more headaches than any rate chart ever could.
Official Resources
- Check GAMMIS Fee Schedules — Georgia Medicaid Management Information System
- Verify Nursing Home Rates — Georgia Department of Community Health
- Find State Medicaid Reimbursement Rules — Medicaid.gov
- See APR-DRG & IPPS Guidance — Centers for Medicare & Medicaid Services (CMS)
Disclaimer: Rates and billing rules shift over time. Before billing or making any financial decision, check the current GAMMIS fee schedule, your provider manual, the terms of any managed-care contract that applies, and whatever official guidance is in effect at that moment.
About Naseer
Naseer has 10+ years of experience creating informative content and researching medicare topics. He focuses on simplifying Medicaid and benefits details to support readers find clear, reliable, and easy-to-understand guidance.