Georgia does not post one single fee schedule for all Medicaid services. Instead, the state lists separate 2026 rate files by provider type, like physician, hospital, and pharmacy.
This guide shows you where to find each schedule and how 2026 rates are calculated.
Quick Summary:
- Georgia posts 2026 fee schedules by provider category, not as one master list
- Physician rates are set near 90% of Medicare’s 2026 fee schedule, plus a 2.154% increase
- Hospitals pay a provider fee and receive add-on payments under SFY 2026 rules
- A July 1, 2026 revalidation deadline has already caused provider payment suspensions
- Learn who qualifies first: Medicaid Eligibility in 2026
Page Contents
- 1 Critical Alert: July 2026 Provider Suspensions
- 2 Official 2026 Fee Schedule Access
- 3 2026 Reimbursement Rates & Formulas
- 4 Key 2026 Deadlines & Updates
- 5 If You Cannot Find Your Code
- 6 Frequently Asked Questions
- 6.1 Q: Does Georgia Medicaid have one master fee schedule for 2026?
- 6.2 Q: Why were Georgia Medicaid providers suspended in July 2026?
- 6.3 Q: Can a suspended provider get paid retroactively after revalidating?
- 6.4 Q: How are Georgia Medicaid physician rates calculated in 2026?
- 6.5 What provider fee do Georgia hospitals pay in 2026?
- 6.6 Q: How often does Georgia update its Medicaid fee schedules?
- 7 Sources & Disclaimer
Critical Alert: July 2026 Provider Suspensions
Georgia Medicaid suspended providers who missed a federal revalidation deadline. This affects claims and payments right now. If you are a provider, check your status today.
What Happened on July 1, 2026
Federal rules require state Medicaid agencies to revalidate every enrolled provider at least once every five years. Georgia’s Department of Community Health identified providers who had not completed this revalidation, and effective July 1, 2026, suspended their enrollment. This means those providers can no longer bill Georgia Medicaid.
The suspension applies to providers serving Traditional Fee-for-Service Medicaid, PeachCare for Kids, and the Georgia Families managed care plans run by Amerigroup, CareSource, and Peach State Health Plan. No provider type is exempt from this rule.
Why Claims Are Being Denied
Claims with dates of service on or after July 1, 2026 will not be paid for suspended providers. There is no retroactive enrollment. Payment eligibility starts only on the date you submit your revalidation application, not the date you were originally suspended.
How to Fix a Suspended Enrollment
Submit your revalidation application through the GAMMIS Enrollment Wizard as soon as possible. Every day you wait is a day of unpaid claims. You can also check the Provider Revalidation Past Due Report to confirm your current status or begin an appeal.
Official 2026 Fee Schedule Access
Georgia Medicaid fee schedules live on the GAMMIS web portal, sorted by provider type. You will not find a single downloadable file for every service. Instead, you pick your category and download that specific rate list.
Where to Find the GAMMIS Fee Schedule Portal
The official source is the GAMMIS Fee Schedules page, found under Provider Information. This is the only place to get verified, current rate data. Bookmark this page if you bill Medicaid regularly.
Follow these steps to reach your fee schedule:
- Go to the Provider Information tab on the GAMMIS homepage.
- Select Fee Schedules from the dropdown menu.
- Accept the license agreement to unlock the search tool.
- Choose your program, such as Physician, Hospital, or Vision, and select 2026 service dates.
What You’ll Find by Provider Category
The portal lists several 2026 files with a 07/01/2026 release date. These include Anesthesia CPT & Base Units, Durable Medical Equipment Services, Orthotic & Prosthetic Services, Outpatient Site of Service Maximum Allowable Payment, Physician Fee Schedule, and Provider’s Administered Drug List. A Zipped Fee Schedule for the 2nd Quarter of 2026 is also available for bulk download.
2026 Reimbursement Rates & Formulas
Rate calculations differ by provider category. Each type uses its own formula, tied to fiscal year adjustments and federal benchmarks. Here is how the major categories are calculated for 2026.
Physician & Professional Rates
Physician payments are largely benchmarked at 90% of the 2026 Medicare Physician Fee Schedule, plus legislative increases. A reported 2.154% adjustment has been applied to base rates this year. The FY 2026 state budget includes $23 million set aside specifically for provider rate increases.
Hospital Rates and Provider Fees
Hospital rates follow the State Fiscal Year cycle, running from July 1, 2025 through June 30, 2026. Hospitals are assessed a provider fee of 1.45% of net patient revenue, with a lower 1.40% fee for trauma centers, to help fund supplemental Medicaid payments.
Inpatient base rates and Graduate Medical Education add-ons include an 11.88% increase for qualifying admissions. The GAMMIS portal also lists an updated SFY 2026 Hospital Provider Fee Payment Schedule, so always confirm you’re viewing the most recent posted version.
Pharmacy Reimbursement Methodology
Pharmacy claims continue to use the National Average Drug Acquisition Cost, or NADAC, formula. This method ties reimbursement to real market drug prices. It helps keep pharmacy payments aligned with what pharmacies actually pay to acquire medications.
For a full breakdown of how these rates compare across states, see this Medicaid Fee Schedule 2026 overview.
Key 2026 Deadlines & Updates
Several deadlines affect Georgia Medicaid providers this year. Missing one can mean unpaid claims or lost enrollment. Here is what you need to track.
Revalidation Deadline: July 1, 2026 (Passed)
This deadline has already passed. If you missed it, act now. Submit your application through the Enrollment Wizard immediately to begin lifting your payment suspension.
FY 2026 State Budget and Funding
Georgia’s Fiscal Year 2026 budget allocated $5.5 billion in state funds to the Department of Community Health. This funding supports continued coverage under Medicaid and PeachCare for Kids. It also helps fund the rate increases described above.
Quarterly Fee Schedule Updates
Fee schedules update four times a year, in January, April, July, and October. Always download the file matching your specific date of service. Using an outdated file can cause claim denials or incorrect payments.
If You Cannot Find Your Code
Sometimes a CPT or HCPCS code will not appear on the fee schedule download. This does not always mean the service isn’t covered. Here’s what to do next.
Unlisted Codes and Manual Pricing
If your code is missing, it may require manual pricing through a paper claim with an invoice attached. In some cases, the service may simply be non-covered under Georgia Medicaid. Check the most recent quarterly file before assuming a code is missing.
Who to Contact for Fee Discrepancies
For rate questions or coding discrepancies, contact the Gainwell Technologies Provider Contact Center at 1-800-766-4456, or locally at 770-325-9600. Have your provider ID and the specific code ready when you call. This speeds up resolution significantly.
Frequently Asked Questions
Q: Does Georgia Medicaid have one master fee schedule for 2026?
A: No. Georgia posts separate fee schedules by provider type, such as physician, hospital, and pharmacy. You must select your specific category on the GAMMIS portal to find the correct 2026 rates for your services.
Q: Why were Georgia Medicaid providers suspended in July 2026?
A: Providers who did not complete federally required revalidation were suspended effective July 1, 2026. Claims for suspended providers with dates of service on or after that date will not be paid until revalidation is complete.
Q: Can a suspended provider get paid retroactively after revalidating?
A: No. There is no retroactive enrollment allowed. Payment eligibility begins only on the date the provider submits their revalidation application, not on any earlier date of service.
Q: How are Georgia Medicaid physician rates calculated in 2026?
A: Physician rates are largely benchmarked at 90% of the 2026 Medicare Physician Fee Schedule. A reported 2.154% increase has been added to base rates, supported by $23 million in dedicated FY 2026 funding.
What provider fee do Georgia hospitals pay in 2026?
A: Hospitals pay a provider fee of 1.45% of net patient revenue, while trauma centers pay a reduced 1.40% fee. This fee helps fund supplemental Medicaid payments across the state’s hospital system.
Q: How often does Georgia update its Medicaid fee schedules?
A: Fee schedules update quarterly, in January, April, July, and October. Always download the version matching your exact date of service to avoid claim errors or payment delays.
Sources & Disclaimer
Written & Reviewed by Akash Biswas, MSW | Former Medicaid Caseworker Trainer | Verified against official Medicaid.gov and Georgia Department of Community Health guidelines | Last Updated: July 2026
To understand income rules alongside these provider rates, see Medicaid income limits by state in 2026.
Sources:
- Georgia Department of Community Health — Provider Revalidation Deadline Announcement
- GAMMIS Provider Portal — Fee Schedules
- Georgia Department of Community Health — Hospital Provider Fee Payment
Disclaimer: CheckMedicaid.com is not affiliated with any government agency. This content is for educational purposes only. For official eligibility or billing questions, contact your state Medicaid office or visit Medicaid.gov.
