---
title: Amerigroup Georgia ABA coverage (GA Medicaid CMO).
url: "https://carelu.com/payers/amerigroup-georgia"
markdown_url: "https://carelu.com/payers/amerigroup-georgia.md"
state: GA (Georgia)
payer: Amerigroup (GA Medicaid CMO)
kind: Medicaid managed care plan (MCO)
parent_program: Georgia Medicaid
description: "How Amerigroup administers ABA for Georgia Medicaid — the CG-BEH-02 adaptive behavioral treatment guideline aligned to the DCH ASD manual, with prior authorization and medical-necessity review."
last_reviewed: October 2026
vob_data_updated: 2026-10-15
---

# Amerigroup Georgia ABA coverage (GA Medicaid CMO).

_Payer Guide · Amerigroup (GA) · Last updated October 2026 · 10 primary sources_

> PA through the GAMMIS portal under DCH ASD rules; 2017 CG-BEH-02 is off the adopted list.

Amerigroup is a Georgia Medicaid CMO that administers ABA under its Adaptive Behavioral Treatment for ASD guideline (CG-BEH-02), aligned to the Georgia DCH ASD manual. Its published guideline has an older revision date, so verifying the current version on the Amerigroup provider portal is especially important here.

This plan administers the **Georgia Medicaid** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Georgia Medicaid guide](https://carelu.com/payers/georgia-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — outpatient behavioral-health PA requests go through the GAMMIS Centralized Authorization Portal (Amerigroup BH addendum, November 2025), reviewed against the DCH ASD manual; ABA request questions go to AGPAutism@amerigroup.com [1][4][2]
- **Prior auth for treatment**: Required — outpatient behavioral-health PA requests go through the GAMMIS Centralized Authorization Portal (Amerigroup BH addendum, November 2025), reviewed against the DCH ASD manual; ABA request questions go to AGPAutism@amerigroup.com [1][4][2]
- **Autism diagnosis required?**: Yes — DSM-5 ASD per the DCH ASD manual [3][4]

## At a glance

- **Plan type:** Georgia Medicaid CMO (managed care)
- **Guideline:** CG-BEH-02 (Adaptive Behavioral Treatment for ASD)
- **Aligned to:** Georgia DCH Part II ASD manual
- **Prior auth:** Required; medical-necessity review
- **Caution:** Published guideline dated 2017/2018 — verify current version
- **Note:** Amerigroup's Georgia CMO status was affected by the 2024 rebid
- **Diagnosis recency:** Eval within 5 years (DCH-aligned criteria)

## How Amerigroup administers the benefit

ABA for Amerigroup members is prior-authorized. The plan's Behavioral Health addendum (November 2025) says “all outpatient prior authorization requests, except for psychological testing, IOP, and PHP, should be submitted through the Centralized Authorization Portal on the GAMMIS website,” for “the number of units and type of services indicated by the individualized recovery plan (IRP)” and expected to be used in the next six months; Amerigroup processes them “as soon as possible, up to the allowed 3 business days.” Keep the submission confirmation number. “For any questions regarding ABA requests email AGPAutism@amerigroup.com,” and reconsiderations may be emailed to GABHOPRECON@amerigroup.com. [3][2][1][4]

Which criteria apply is less clear than it used to be. The guideline Amerigroup posts for ABA, CG-BEH-02, is dated 2017 (current effective date 9/27/2017, last review 8/3/2017), and it is not on Amerigroup's current list of Clinical UM Guidelines adopted for Georgia Medicaid members (August 2026), whose only BEH entries are CG-BEH-14 (intensive in-home behavioral health) and CG-BEH-15 (activity therapy for autism and Rett syndrome). The plan publishes no replacement ABA guideline, so build requests to the DCH ASD manual's rules and confirm any plan-specific limit with AGPAutism@amerigroup.com before relying on the 2017 figures. [3][2][1][4]

Two DCH rules matter most at renewal and on the claim. A continued-treatment request needs progress and probe data that “must not be more than two months older than the effective date of the requested prior authorization,” and since October 2026 skill-acquisition line graphs. Codes: Georgia Medicaid's ABS code set is CPT 97151–97158, 0362T and 0373T, each with a U1–U5 practitioner modifier and a U6, U7 or GT setting modifier. The 2017 CG-BEH-02 also lists HCPCS H0031, H0032, H0046, H2012, H2014 and H2019 “when specified as ABT therapy,” but that is a multi-state code table in a guideline Amerigroup no longer lists as adopted, and Amerigroup publishes no Georgia ABA code list of its own, so do not bill H-codes for ABA without written confirmation from Amerigroup. [3][2][1][4]

## How do I join the Amerigroup ABA network, and is it open?

Amerigroup’s Georgia manual: “All providers and facilities must obtain credentialing approval from the DCH Centralized Credentialing Verification Organization (CVO) before they can become eligible to participate as an Amerigroup provider.” Contracting is a separate step: “You must enter into a participating agreement if you are interested in participating in the Amerigroup network,” requested through Availity Essentials (Payer Spaces, Amerigroup, Applications, Provider Enrollment and Network Management) or the Join Our Network link at provider.amerigroup.com/GA. [6][4]

Whether Amerigroup is accepting new ABA groups is not published. Ask Amerigroup network management. Individual practitioners must also meet DCH’s enrollment rules (Georgia licence and active BACB certification; the residence rule was dropped in October 2026). [6][4]

## Can an out-of-state BCBA treat a Georgia member, including by telehealth?

Georgia licenses the practice: “The unlicensed practice of applied behavior analysis is prohibited in this state,” at a fine of $1,000 per violation (O.C.G.A. 43-7A-6, added by HB 412, effective July 1, 2023). A BCBA “residing and practicing in another state who temporarily provides applied behavior analysis services in this state to a resident of this state” may apply for a temporary license covering “not more than a total of 30 days within a calendar year” (43-7A-8), and the board licenses by reciprocity someone actively licensed in a state with comparable requirements that reciprocates with Georgia (43-7A-9). As enacted, Chapter 7A contains no telehealth exception. [7][4][8]

Georgia Medicaid no longer has a residence test. The October 2026 ASD manual removed the requirement to live in Georgia or within 50 miles of its border (601.1.2); now “to enroll as a BCBA/BCBA-D Medicaid provider, practitioners must maintain an active certification issued by the BACB and hold a valid license from the Georgia Behavior Analyst Licensing Board.” [7][4][8]

Federal rules make the state Medicaid enrollment rule binding on the plan: the state “must screen and enroll, and periodically revalidate, all network providers” of Medicaid managed care plans (42 CFR 438.602(b)(1)). So a BCBA in Amerigroup’s network has to be enrolled with Georgia Medicaid as well. [7][4][8]

## Amerigroup Georgia ABA claims: filing deadline, payment, taxonomy and disputes

Filing deadline: “All claims must be submitted within six months after the month in which service was rendered”; corrected claims must be submitted within 90 days of the original claim submission. With other coverage, “the time frames for filing a claim will begin on the date that the third party documents resolution of the claim.” Payment: “Clean claims are adjudicated within 15 business days of receipt of a clean claim,” with interest if Amerigroup misses that clock, and a claim that is not clean is pended in writing within 15 business days. [6][9]

Taxonomy: Amerigroup has “aligned our NPI and taxonomy code requirements with those of the state of Georgia,” and the required claim data include the “NPI and taxonomy code.” [6][9]

Disputes: two steps. A reconsideration within 90 calendar days of the EOP date, online, in writing or by phone, which Amerigroup tries to resolve within 30 calendar days (extendable by 30); then a claim payment appeal within 30 calendar days of the reconsideration letter. A state fair hearing request must reach Amerigroup in writing within 15 business days of the payment dispute resolution letter (O.C.G.A. 49-4-153(e)). A medical-necessity appeal of a payment decision must be received within 30 calendar days of the EOB date. [6][9]

Electronic Visit Verification does not reach ABA in Georgia. DCH’s EVV program covers Personal Support Services/Community Living Supports (T1019 and T1020) in the SOURCE, CCSP, NOW, COMP, ICWP and GAPP waivers, plus home health care (S5125 and S5126); ABA codes are not on the list. Amerigroup’s Georgia manual sets no EVV rule of its own. [6][9]

## Intake gates

The questions that decide whether a family can start with Amerigroup (GA Medicaid CMO), and what they have to bring.

- **Age limit**: Follows the Georgia Medicaid rule: Adaptive Behavior Services are an EPSDT benefit and “Autism Spectrum Services are for individuals under the age of 21.” Amerigroup’s UM Guideline CG-BEH-02 publishes no age criterion of its own — it is a medical-necessity guideline keyed to whether “a state mandate requires or a benefit plan explicitly provides coverage for ABT,” not an eligibility document. [4][3]
  - Ask the plan: Note the vintage: the posted CG-BEH-02 is dated June 2018 (GAPEC-2437-18) and Amerigroup GA is operating under a DCH contract extension through 6/30/2027 — confirm the current guideline on the Amerigroup/Wellpoint provider portal.
- **Diagnosis recency**: Amerigroup publishes no window of its own — CG-BEH-02 requires a diagnosis of ASD and goals “based on standardized assessments” but names no recency rule, and the March 2026 Georgia Medicaid provider manual adds none — so the Georgia Medicaid rule governs. A diagnostic re-evaluation may be required when the diagnosis is provisional, when no formal neuropsychological evaluation was done, or when it is “more than 5 years from initial diagnosis and no evidence of ongoing assessment and treatment,” and the behavioral assessment “must have been conducted/dated no more than two (2) months prior to the Treatment PA effective date.” [4][3][6]
- **Who may diagnose**: The Georgia Medicaid rule governs. Amerigroup’s posted 2017 guideline CG-BEH-02 (no longer on its adopted Clinical UM Guidelines list, August 2026) was scope-of-practice based and deliberately broad: “a diagnosis of ASD has been made by a licensed medical professional or other qualified health care professional as is consistent with state licensing requirements.” The guideline separately required documentation “that ABT services will be delivered by an appropriate provider who is licensed or certified according to applicable state laws and benefit plan requirements.” The Georgia floor is narrower and governs for Medicaid members: the diagnosis must be established by a licensed physician or psychologist, or another licensed professional designated by the Medical Composite Board, and made by a practitioner enabled by the Georgia practice acts to diagnose behavioral health, intellectual or developmental conditions. [3][4]
- **Diagnostic tools required**: CG-BEH-02 names no instrument. It requires that “assessments of motor, language, social, and adaptive functions have been completed” and that treatment-plan goals be “in objective and measurable terms based on standardized assessments.” Which instruments qualify is left to the Georgia Medicaid rule, which governs Amerigroup members: at least two tools, “1 primary clinician tool and 1 caregiver tool,” from DCH’s approved list (for example ADOS-2 or CARS-2 plus ADI-R or SRS-2), and school psychoeducational assessments are not acceptable. [3][4]
- **Referral required?**: CG-BEH-02 is a medical-necessity guideline and states no referral gate, so the Georgia Medicaid structure governs: ASD services must be recommended by a licensed physician or other licensed practitioner of the healing arts acting within their scope of practice under state law per 42 CFR 440.130(c); all ABS prior authorizations must be requested by the enrolled QHCP (a licensed physician, psychologist, BCBA-D or BCBA — never a BCaBA or RBT); and the ordering, prescribing or referring practitioner’s NPI must appear on the CMS-1500 in box 17 with the DK, DN or DQ qualifier and be enrolled in Georgia Medicaid, or the claim denies. Assessment and treatment are authorized separately — assessment in three-month increments, treatment in six. Amerigroup adds a records rule of its own for behavioral-health services: its Behavioral Health addendum (November 2025) says “providers must submit a signed service order by an appropriately credentialed practitioner along with a comprehensive assessment” describing the member's physical and mental health status at admission to services; it does not say who counts as appropriately credentialed for ABA or how long the order stays valid. [1][5][4][3]
- **Telehealth**: CG-BEH-02 contains no telehealth provision, so the Georgia Medicaid floor governs: under the DCH Part II Telehealth Guidance (version date 10/1/2026), “practitioners of ASD services can use telehealth to assess, diagnose and provide therapies to patients,” and the guidance publishes the billable ABS telehealth codes — 97151–97158, 0362T and 0373T in 15-minute units with the GT modifier plus the U1–U5 practitioner-level modifier, on POS 02 (member outside the home) or POS 10 (member at home). Prior authorization applies to telehealth ABS exactly as in person. Assessment and supervision by telehealth follow the same state floor: 97151 and 97152 are on DCH's telehealth code table, and 97155 (protocol modification, the code that carries the analyst's direction of the technician) is on it at the U1–U3 levels only (physician, psychologist/BCBA-D, BCBA). DCH's ASD manual (October 2026) says supervision “does not require the supervisor to be present at the work site with the supervisee, but the provision of in-person supervision must be performed at a frequency to ensure quality of the services being provided” — some in-person supervision is expected, at no set share; supervision itself is built into the direct-service rates, and only direction billed as 97155 is paid. [4][5][3]
  - Ask the plan: Amerigroup/Wellpoint Georgia provider services for any plan-level restriction the posted 2018 guideline would not show.
- **Prior-auth decision time**: Amerigroup's Georgia Medicaid manual: "Amerigroup will decide on pre-service nonurgent care services within three business days from when we receive the request for service," and providers are notified through Availity or the MMIS portal in the same three business days. It may add 14 calendar days if the member or provider asks, or Amerigroup justifies needing more information to DCH. Expedited requests are decided "within 24 clock hours from when we receive the request for service," with notice "no later than 72 hours from the receipt of the request." The manual publishes no reauthorization lead time for ABA. Its 30-days-before-expiry renewal rule covers medical injectable and pharmacy PAs only. The ABA guideline expects the treatment plan to be updated and resubmitted "in general, every 6 months." [6][3][13][14]
- **Other insurance (who pays first)**: "Amerigroup agrees that the Medicaid program will be the payer of last resort when third-party resources are available." When it knows of other coverage before paying, Amerigroup will reject the claim and redirect "the provider to bill the appropriate insurance carrier." When it learns later, it recovers after payment. "State-specific guidelines will be followed when Coordination of Benefits (COB) procedures are necessary." For COB, "the time frames for filing a claim will begin on the date that the third party documents resolution of the claim." The manual publishes no pay-and-chase exception. Get Medicaid's own PA even when Medicaid is secondary. DCH's Part I manual: "Regardless of whether or not the primary plan has made any payment toward a service, when billing the secondary claim to Medicaid, you must follow the Medicaid policies and procedures for that particular Category of Service, including adherence to all policies/guidelines for pre- certification and pre-authorizations of services." TRICARE pays only after other coverage "except in the case of a plan administered under title XIX" (Medicaid), so TRICARE goes before Georgia Medicaid. CHAMPVA is the reverse: "If you are eligible under Medicaid, CHAMPVA will pay first." [6][11][15][16]

## Delivery and billing rules

Coverage decides whether Amerigroup (GA Medicaid CMO) pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Concurrent billing (97153 + 97155)**: The Georgia Medicaid rule applies, because Amerigroup publishes none of its own: neither CG-BEH-02, the Georgia Medicaid provider manual (March 2026) nor the Behavioral Health addendum (November 2025) sets a same-clock-time rule for 97153 with 97155. DCH's ASD manual allows concurrent billing for direction: when the analyst observes the technician and modifies or demonstrates a protocol, that time is billed as 97155 and “the technician's time is separately reportable under 97153,” face-to-face with the patient; 97154 and 97158 should not be billed concurrently, and when the analyst directs a technician-led group, 97154 and 97155 are reported together. Time that is only supervision, or that happens with the member absent, cannot be billed as 97155. On ABA alongside other therapies, CG-BEH-02 (reviewed 2017) has no billing rule; its Georgia Medicaid continuation criterion only stresses "the importance of coordinating ABS services with any other modality/service/therapy being received by the child at the same time." Under the DCH manual: ABA alongside speech, OT or PT — the Part II ASD manual sets no rule on ABA billed at the same clock time as another therapy. What it requires is coordination — the care plan must include "clear and specific coordination with all providers involved in the treatment of the individual" (602.3.2), treatment goals must "avoid duplication of other services" (Appendix F), the treatment-plan template asks for "Other Services (OT, SLP, PT, etc.)" and "Coordination of Care with Other Providers", and the required PA cover sheet (Appendix D) asks which private or school occupational, speech or physical therapy the member receives. On the claim, Part I §§209–210 apply the Medicaid NCCI edits "to services performed by the same provider for the same beneficiary on the same date of service"; in CMS's Medicaid practitioner PTP table active 10/1–12/31/2026, speech code 92507 bundles 97153–97157 and 0373T, 97153 bundles group speech 92508, and OT/PT code 97530 bundles 97153–97158 — all with modifier indicator 0, so one provider billing both on the same date loses the column-two line with no modifier override. [6][1][3][4][11][12]
  - Ask the plan: Amerigroup/Wellpoint Georgia provider services, and the Georgia fee schedule inside GAMMIS.
- **Session-note signature**: The person who delivered the service signs. Amerigroup's Behavioral Health addendum (November 2025) lists what every progress note must carry: the member's correct name and ID, the correct code for the service and for the practitioner level, “beginning and ending time of the service,” total units, an intervention tied to a treatment-plan goal, a structured note format (BIRP, SOAP or similar), support for the units used, the “name, signature, and credentials of the person providing the service,” and “the date the note was signed (time and date stamped).” Treatment plans carry the signatures of the provider who completed them and of the member or family. The Georgia Medicaid floor adds the ABA specifics: for RBT- or BCaBA-rendered services such as 97153, “the RBT or BCaBA delivering the service is responsible for completing and signing the daily session or progress note,” and since October 2026 each note is due no later than one business day after the date of service. [1][4]
- **Place of service**: Amerigroup publishes no place-of-service rule for ABA — neither CG-BEH-02 nor its Georgia Medicaid provider manual (March 2026) addresses setting — so the Georgia Medicaid rule applies: U6 in-clinic, U7 out-of-clinic (any location outside the agency or clinic), GT telemedicine. School delivery is allowed only under a separate school plan (target behaviors, line graphs, a titration plan, and the IEP, IFSP or 504 plan for a public-school student) that sits alongside a home and/or clinic plan. [4][6][3]
- **Bill as provider**: Amerigroup sets no rule of its own, so the Georgia Medicaid rule applies: for RBT- or BCaBA-rendered services such as 97153, “the supervising BCBA must be identified as the rendering provider on the claim”; BCaBAs and RBTs are not enrolled as providers, and their services are claimed under the enrolled QHCP’s and/or facility’s provider number, with the U1–U5 practitioner-level modifier and the U6/U7/GT setting modifier. Multi-clinician practices enroll as a group, with each QHCP linked as a rendering provider. [4][6][3]

## What intake should collect for Amerigroup (GA Medicaid CMO)

- **Amerigroup member ID:** Confirm the plan and current CMO status at intake.
- **DSM-5 ASD diagnosis:** Per the DCH manual criteria the guideline aligns to.
- **Medical-necessity documentation:** Required for the prior-authorization request.
- **Plan of Care:** Measurable, baseline-anchored goals consistent with the DCH manual.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Verification of benefits (VOB) data

How Amerigroup (GA Medicaid CMO) ABA benefits route and read on an eligibility check. Data last updated 2026-10-15.

### EDI routing

- **Payer ID (pVerify):** 00025 — pVerify lists a generic "00025 AMERIGROUP" (Elig: Y) plus a separate GA-inclusive entry "00706 AMERIGROUP (IA,DC,MD,FL,GA,WA,TN,TX,NM)" flagged Elig/Claim: No in pVerify's own table — confirm which code pVerify actually routes GA eligibility checks through before automating on 00025.
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** none
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required | 32 units/day per day (inferred) | Inferred: GA DCH in-clinic (U6) / out-of-clinic (U7) / telehealth (POS 02 or 10, GT) — not confirmed in Amerigroup’s own guideline | Inferred — GA DCH mechanics (GT modifier, POS 02/10); not confirmed in Amerigroup's own guideline. | Inferred: GA DCH U1–U7 tiers/setting modifiers, GT telehealth |
| 97152 | Yes | Required | 16 units/day per day (inferred) | Inferred: GA DCH in-clinic (U6) / out-of-clinic (U7) / telehealth (POS 02 or 10, GT) — not confirmed in Amerigroup’s own guideline | Inferred — GA DCH mechanics (GT modifier, POS 02/10); not confirmed in Amerigroup's own guideline. | Inferred: GA DCH U1–U7 tiers/setting modifiers, GT telehealth |
| 97153 | Yes | Required | 32 units/day per day (inferred) | Inferred: GA DCH in-clinic (U6) / out-of-clinic (U7) / telehealth (POS 02 or 10, GT) — not confirmed in Amerigroup’s own guideline | Inferred — GA DCH mechanics (GT modifier, POS 02/10); not confirmed in Amerigroup's own guideline. | Inferred: GA DCH U1–U7 tiers/setting modifiers, GT telehealth |
| 97154 | Yes | Required | 18 units/day per day (inferred) | Inferred: GA DCH in-clinic (U6) / out-of-clinic (U7) / telehealth (POS 02 or 10, GT) — not confirmed in Amerigroup’s own guideline | Inferred — GA DCH mechanics (GT modifier, POS 02/10); not confirmed in Amerigroup's own guideline. | Inferred: GA DCH U1–U7 tiers/setting modifiers, GT telehealth |
| 97155 | Yes | Required | 24 units/day per day (inferred) | Inferred: GA DCH in-clinic (U6) / out-of-clinic (U7) / telehealth (POS 02 or 10, GT) — not confirmed in Amerigroup’s own guideline | Inferred — GA DCH mechanics (GT modifier, POS 02/10); not confirmed in Amerigroup's own guideline. | Inferred: GA DCH U1–U7 tiers/setting modifiers, GT telehealth |
| 97156 | Yes | Required | 16 units/day per day (inferred) | Inferred: GA DCH in-clinic (U6) / out-of-clinic (U7) / telehealth (POS 02 or 10, GT) — not confirmed in Amerigroup’s own guideline | Inferred — GA DCH mechanics (GT modifier, POS 02/10); not confirmed in Amerigroup's own guideline. | Inferred: GA DCH U1–U7 tiers/setting modifiers, GT telehealth |
| 97157 | Yes | Required | 16 units/day per day (inferred) | Inferred: GA DCH in-clinic (U6) / out-of-clinic (U7) / telehealth (POS 02 or 10, GT) — not confirmed in Amerigroup’s own guideline | Inferred — GA DCH mechanics (GT modifier, POS 02/10); not confirmed in Amerigroup's own guideline. | Inferred: GA DCH U1–U7 tiers/setting modifiers, GT telehealth |
| 97158 | Yes | Required | 16 units/day per day (inferred) | Inferred: GA DCH in-clinic (U6) / out-of-clinic (U7) / telehealth (POS 02 or 10, GT) — not confirmed in Amerigroup’s own guideline | Inferred — GA DCH mechanics (GT modifier, POS 02/10); not confirmed in Amerigroup's own guideline. | Inferred: GA DCH U1–U7 tiers/setting modifiers, GT telehealth |
| 0362T | Yes | Required | 16 units/day per day (inferred) | Inferred: GA DCH in-clinic (U6) / out-of-clinic (U7) / telehealth (POS 02 or 10, GT) — not confirmed in Amerigroup’s own guideline | Inferred — GA DCH mechanics (GT modifier, POS 02/10); not confirmed in Amerigroup's own guideline. | Inferred: GA DCH U1–U7 tiers/setting modifiers, GT telehealth |
| 0373T | Yes | Required | 32 units/day per day (inferred) | Inferred: GA DCH in-clinic (U6) / out-of-clinic (U7) / telehealth (POS 02 or 10, GT) — not confirmed in Amerigroup’s own guideline | Inferred — GA DCH mechanics (GT modifier, POS 02/10); not confirmed in Amerigroup's own guideline. | Inferred: GA DCH U1–U7 tiers/setting modifiers, GT telehealth |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Verify via: Amerigroup Georgia provider portal / current UM guideline — the published CG-BEH-02 (2017/2018) predates 97151–97158 and contains no code-level billing detail; every field on this entry is inferred from the statewide DCH/CMS pattern, not confirmed against Amerigroup's own current criteria.

### Contacts

- **Benefits by phone:** Yes
- **Provider services phone:** 1-800-454-3730
- **Hours:** Monday–Friday, 7 a.m.–7 p.m.
- **Portal:** [Availity Essentials](https://apps.availity.com/availity/web/public.elegant.login)
- **Fax:** 1-800-964-3627

Questions to ask on a verification call:

- Which pVerify payer ID should we use for Amerigroup GA eligibility checks — the generic 00025, or 00706 (flagged No for eligibility/claims in pVerify's own table)?
- What is Amerigroup GA's correct Availity payer ID — Availity's list resolves 26375 to Amerigroup Fort Worth, TX, not Georgia?
- What Change Healthcare payer ID do you use for Amerigroup GA eligibility checks?
- Does eligibility checking return real-time or batch-only 271 responses?
- Is the ABA cost share a copay or coinsurance, and is it charged per visit or per day?
- Which service-type-code bucket does Amerigroup GA return ABA benefit detail under, and does the deductible or out-of-pocket max apply?

### VOB data sources

- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.mmis.georgia.gov/portal/PubAccess.EDI/Companion%20Guides/tabId/45/Default.aspx (accessed 2026-07-23)
- https://provider.amerigroup.com/docs/gpp/GA_CAID_UMGuideline_AdaptiveBehavioralTreatmentAutismSpectrumDisorder.pdf?v=202101081602 (accessed 2026-07-23; source document older than 18 months)
- https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/Handbooks/Autism%20Spectrum%20Disorder%20Q4-October%202026%2020261001130506.pdf (accessed 2026-09-27)
- https://www.mmis.georgia.gov/portal/portals/0/staticcontent/public/all/notices/autism%20spectrum%20disorder%202023%20(002)%2020230209200139.pdf (accessed 2026-07-23; source document older than 18 months)
- https://provider.amerigroup.com/georgia-provider/contact-us (accessed 2026-07-23)
- https://provider.amerigroup.com/docs/gpp/GA_CAID_ProviderManual.pdf (accessed 2026-10-14)

## Common questions

### How long do I have to file an Amerigroup Georgia ABA claim, or correct one?

Six months after the month of service; corrected claims within 90 days of the original submission. When another insurer is involved, the clock starts when the third party documents its resolution of the claim.

### Does Amerigroup Georgia cover ABA therapy?

Yes — Amerigroup administers the Georgia Medicaid ABA benefit under its CG-BEH-02 adaptive behavioral treatment guideline, aligned to the DCH ASD manual, with prior authorization and medical-necessity review.

### Is Amerigroup's Georgia ABA guideline current?

Probably not. The posted ABA guideline, CG-BEH-02, is dated 2017 and does not appear on Amerigroup's August 2026 list of Clinical UM Guidelines adopted for Georgia Medicaid members. Amerigroup publishes no replacement, so follow the DCH ASD manual and ask AGPAutism@amerigroup.com about any plan-specific limit.

### Where do I send an Amerigroup Georgia ABA prior authorization (for example 97151/97152)?

Through the GAMMIS Centralized Authorization Portal, which Amerigroup's Behavioral Health addendum names for all outpatient behavioral-health PA requests except psychological testing, IOP and PHP. Amerigroup processes them within up to 3 business days; questions about ABA requests go to AGPAutism@amerigroup.com. Amerigroup publishes no ABA packet list of its own, so assemble the DCH ASD manual's assessment packet.

### Can Amerigroup Georgia authorize ABA retroactively?

Its Behavioral Health addendum says outpatient service authorizations “will start on the date of receipt of the request,” so plan for no backdating; submit before services begin.

### Is the Amerigroup Georgia Medicaid ABA network open to new providers?

Get credentialed by DCH’s centralized CVO, then sign a participating agreement through Availity (Provider Enrollment and Network Management) or the Join Our Network link. Amerigroup does not publish whether its ABA network is open, so ask network management.

### Can an out-of-state BCBA treat Amerigroup members in Georgia, including by telehealth?

Georgia prohibits unlicensed ABA practice (O.C.G.A. 43-7A-6); a temporary license of up to 30 days a year and reciprocity exist. To enroll in Georgia Medicaid a BCBA needs a Georgia license and active BACB certification; since October 2026 there is no requirement to live in Georgia or within 50 miles of its border.

### What is Amerigroup Georgia’s timely filing limit for ABA claims?

Six months after the month the service was rendered; corrected claims within 90 days of the original submission (Amerigroup Georgia Medicaid provider manual).

### How do I dispute an Amerigroup Georgia ABA claim?

Ask for a reconsideration within 90 calendar days of the EOP, then a claim payment appeal within 30 calendar days of the reconsideration letter; a state fair hearing request is due within 15 business days of the dispute resolution letter.

## Primary sources

1. [Amerigroup Georgia — Provider Manual Behavioral Health Addendum (GAAGP-CD-PM-090843-25, November 2025)](https://provider.amerigroup.com/docs/gpp/GA_CAID_ProviderManualBehavioralHealthAddendum.pdf)
2. [Amerigroup Georgia — Clinical Utilization Management Guidelines adopted for Medicaid members (GA-AGP-CD-018568-26, August 2026)](https://provider.amerigroup.com/docs/gpp/GA_CAID_FEB26CUMG.pdf)
3. [Amerigroup — Adaptive Behavioral Treatment for ASD (CG-BEH-02, GA Medicaid)](https://provider.amerigroup.com/docs/gpp/GA_CAID_UMGuideline_AdaptiveBehavioralTreatmentAutismSpectrumDisorder.pdf?v=202101081602)
4. [GA DCH — Part II Policies and Procedures for Autism Spectrum Disorder (ASD) Services, version date October 1, 2026 (GAMMIS)](https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/Handbooks/Autism%20Spectrum%20Disorder%20Q4-October%202026%2020261001130506.pdf)
5. [GA DCH — Part II Policies and Procedures for Telehealth Guidance, version date October 1, 2026 (GAMMIS)](https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/Handbooks/Telehealth%20Guidance%20Q4%20-%20October%202026%2020260921152812.pdf)
6. [Amerigroup Georgia Medicaid Provider Manual (GA-AGP-CD-PM-003925-26)](https://provider.amerigroup.com/docs/gpp/GA_CAID_ProviderManual.pdf)
7. [Georgia HB 412 (2022) — O.C.G.A. Title 43, Ch. 7A behavior analyst licensure (effective July 1, 2023)](https://gov.georgia.gov/document/2022-signed-legislation/hb-412/download)
8. [eCFR — 42 CFR 438.602(b)(1): the state must screen and enroll all managed care network providers](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-H/section-438.602)
9. [GA DCH — Electronic Visit Verification (EVV) Member FAQs (last updated December 2020)](https://medicaid.georgia.gov/document/document/evv-faqs/download)
10. [Amerigroup Provider News — Georgia (index)](https://providernews.amerigroup.com/ga)
11. [GA DCH — Part I Policies and Procedures for Medicaid/PeachCare for Kids (version date July 1, 2026), sections 209–210 (NCCI)](https://www.mmis.georgia.gov/portal/Portals/0/StaticContent/Public/ALL/HANDBOOKS/Part%201%20Policies%20and%20Procedures%20for%20Medicaid%20PeachCare%20for%20Kids%20Q3%20July%202026%2020260706155614.pdf)
12. [CMS — Medicaid NCCI PTP edits, practitioner services (2026 Q4, active 10/1–12/31/2026)](https://www.cms.gov/files/zip/medicaid-ncci-2026-q4-ptp-edits-practitioner-services.zip)
13. [42 CFR 438.210(d) — MCO authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
14. [Georgia SB 80 (2021) — O.C.G.A. 33-46-26, -27, -29, -30 (Ensuring Transparency in Prior Authorization Act)](https://gov.georgia.gov/document/2021-signed-legislation/sb-80/download)
15. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage, Medicaid excepted](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
16. [CHAMPVA Guidebook (updated Jan. 1, 2025) — Other Health Insurance](https://www.va.gov/COMMUNITYCARE/docs/pubfiles/programguides/CHAMPVA-Guide.pdf)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.