Home care billing · GA
Home care billing in Georgia
Short answer
Home care billing in Georgia centers on four 1915(c) waivers: the Elderly and Disabled Waiver that DCH labels CCSP and SOURCE, the Independent Care Waiver Program, and the NOW and COMP waivers.
Each personal support visit has to be verified in the state's Netsmart Mobile Caregiver+ EVV system or an integrated third-party vendor, with the T1019 and T2025 modifiers that DCH publishes, and claims and prior authorizations run through GAMMIS. Home health agencies are in scope too: applicable home health claims dated on or after September 14, 2026 must come through EVV. A dedicated Remitwright biller keeps EVV codes, modifiers and GAMMIS claims in step, serving Georgia agencies remotely. Rules for other states are on the home care billing by state page.
Last reviewed by the Remitwright billing team. Editorial policy
Key facts for Georgia home care billing
| Fact | In Georgia | Source |
|---|---|---|
| Programs that pay | Elderly and Disabled Waiver (0112.R08.00); Independent Care Waiver Program, ICWP (4170.R07.00); New Options Waiver, NOW (0175.R07.00); COMP waiver (0323.R06.00) | 1 |
| EVV | Hybrid | 7 |
| Medicare home health and hospice | Palmetto GBA, Jurisdiction M | 11 |
Programs that pay for home care in Georgia1
Elderly and Disabled Waiver (0112.R08.00)
Adult day health, case management, out-of-home respite, personal support services and related home and community-based supports
For individuals ages 65 or older and individuals with physical disabilities ages 0 to 64 who meet a nursing facility level of care.
Independent Care Waiver Program, ICWP (4170.R07.00)
Adult day services in full-day (more than 5 hours) and half-day units and related in-home waiver services
For individuals with physical disabilities or brain injury ages 21 to 64 who meet a hospital or nursing facility level of care.
New Options Waiver, NOW (0175.R07.00)
Community living support, basic and extended, and related supports
For individuals with intellectual or developmental disabilities ages 0 or older who meet an ICF/IID level of care.
COMP waiver (0323.R06.00)
Community access, community living support (basic and extended) and related supports
For individuals with intellectual or developmental disabilities ages 5 or older who meet an ICF/IID level of care.
How the program is delivered
Georgia Families, the CMO program, leaves several home care populations outside managed care. The contract excludes from CMO enrollment recipients eligible for Medicare, recipients enrolled in fee-for-service Medicaid through SSI before CMO enrollment, children in the Georgia Pediatric Program (GAPP), individuals in a hospice or nursing home category of aid, and children in Community Based Alternatives for Youths (CBAY), even when they are otherwise eligible, so those members' claims do not go to a CMO.8 The contract does not list members of the Elderly and Disabled, ICWP, NOW or COMP waivers as an excluded group, so confirm each member's managed care enrollment in GAMMIS rather than assuming a waiver member is fee-for-service.
Electronic visit verification
Hybrid. DCH implemented Netsmart Mobile Caregiver+ as the state EVV solution for personal care services in 2021 and offers it at no cost; a provider may select or keep an alternative third-party EVV system that is integrated with the state solution, pays any cost of that system itself, and must complete a third-party attestation, with the vendor completing its own attestation and returning it to Netsmart.7 The provider is responsible for making sure the system it chooses meets both DCH and 21st Century Cures Act requirements, and the page carries a PDF list of approved vendors. Home health care services followed: DCH's main EVV page sets a soft go-live of August 31, 2026 and requires EVV on applicable home health claims with dates of service on or after September 14, 2026.
Services under EVV6
- Elderly and Disabled Waiver (CCSP and SOURCE, categories of service 590 and 930): personal support services T1019, extended personal support T1019 TF, consumer direct personal support T1019 UC
- Independent Care Waiver Program (660): personal support level I T2025 U5 TF, level II T2025 U5 TG, consumer directed T2025 U5 UC, TBI personal support level I and II T2025 U5 U1 with TF or TG
- NOW and COMP (680 and 681): community living support T2025 with U4 or U5, UN for two members and UP for three, UC for self-directed and UA for co-employer arrangements
- Georgia Pediatric Program, GAPP (971): personal care support S9122, and S9122 U2 for the family caregiver option
- Home health care services (category of service 200, specialty 088): speech therapy 92507, physical therapy 97161 to 97164 and G0151, occupational therapy 97165 to 97168 and G0152, home health aide S9122, skilled nursing S9123 and S9124
Authorizations
For home health care services under EVV, DCH states that physician orders are required and points providers to the applicable Part II policy manuals for prior authorization requirements. The home health EVV soft go-live was August 31, 2026, and since September 14, 2026 all applicable home health claims with dates of service on or after that day must be submitted through EVV.6 At a minimum EVV verifies the type of service, the individual receiving it, the individual providing it, the date, the location and the time the service begins and ends. The therapy evaluation codes carry one unit per day, G0151 and G0152 are 15-minute units, and S9122, S9123 and S9124 are hourly units on the DCH code table.
Where the claims go
GAMMIS. DCH describes the Georgia Medicaid Management Information System as the integration of systems that processes Medicaid and PeachCare for Kids claims and is used for provider enrollment, client eligibility including third party liability, benefit package maintenance, managed care enrollment, claims processing, prior authorizations and notices.10 DCH's provider section includes a home health area for rate setting and cost reports. The web portal and the program manuals sit on GAMMIS, so the filing deadline and prior authorization rules for each home care program come from the current manual there.
Medicare home health and hospice in Georgia
Medicare home health and hospice claims from Georgia agencies go to Palmetto GBA, the home health and hospice contractor for A/B MAC Jurisdiction M, whose HH+H territory covers Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina, Tennessee and Texas.11
Common rejections in Georgia, and the fix
Personal support visit missing from the state EVV system
The fixIf you use a third-party EVV vendor it must be integrated with Netsmart Mobile Caregiver+ and both you and the vendor must have filed the DCH third-party attestation; a visit that stays in your vendor's system never reaches the state. The biller reconciles the visit list against the state system before the claim is built and holds any visit the state does not show.
Wrong modifier on a T1019 or T2025 line
The fixDCH's code table ties each program to its modifiers: plain T1019 for personal support, TF for extended personal support and UC for consumer direct under the Elderly and Disabled Waiver; T2025 U5 with TF or TG for ICWP levels I and II, UC for consumer directed and U1 for the TBI lines; T2025 with U4 or U5 plus UN or UP for two- or three-member community living support under NOW and COMP, UC for self-directed and UA for co-employer. The biller maps the agency's service codes to that table once and locks it in the scrubber.
Home health claim dated September 14, 2026 or later rejected for no EVV
The fixSince September 14, 2026 every applicable home health claim with a date of service on or after that day has to come through EVV, after a soft go-live on August 31, 2026. An agency that has not yet registered and trained on EVV should do so before billing these visits; the biller checks that each skilled nursing, aide and therapy visit has an EVV record before releasing claims dated September 14, 2026 or later.
Claim sent to a CMO for a member the contract excludes
The fixMembers eligible for Medicare, SSI fee-for-service enrollees, GAPP children, people in a hospice or nursing home category of aid and CBAY children are excluded from Georgia Families enrollment. The biller reads the member's managed care enrollment in GAMMIS on the date of service and routes the claim to the state or to the CMO on that basis.
Units do not match the DCH code table
The fixThe home health rows carry their own units: 92507 and the therapy evaluation codes 97161 to 97168 are one unit per day, G0151 and G0152 are 15-minute units, and S9122, S9123 and S9124 are billed per hour. A claim built with the wrong unit basis fails the EVV match even when the visit is there, so the biller sets unit rules per code in the practice management system.
Medicare home health claim sent to the wrong contractor
The fixGeorgia's home health and hospice Medicare claims belong to Palmetto GBA as the HH+H contractor for Jurisdiction M, which is not the same split as the state's Part A and Part B work. The biller keeps a separate payer record for Palmetto GBA HH+H with its own submitter setup.
Remitwright serves Georgia home care and home health agencies remotely, inside the agency software you already use, with a dedicated biller.
FAQ
Questions from Georgia agencies
Which Georgia waivers pay for in-home personal support, and how current are they?
Is Netsmart the only EVV system we can use in Georgia?
Do Georgia home health agencies have to use EVV now?
Are our waiver clients in a CMO or in fee-for-service Medicaid?
Who pays our Medicare home health and hospice claims in Georgia?
Which codes need an EVV record in Georgia, and with which modifiers?
How are home care hours authorized in Georgia?
Where do Georgia home care claims go?
What do you need from us to start billing Georgia home care?
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