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Georgia Medicaid DMA 610 Prior Authorization Request

Georgia Medicaid fee-for-service uses the DMA 610 to request prior authorization for durable medical equipment, orthotics and prosthetics, or case management services. Prescribers meet it when ordering covered equipment or services for a member who is not in a Georgia Families care management organization. The request lists the items, procedure codes, units and months of service, and approval depends on the member's eligibility at the time of service.

Who completes it

The requesting Medicaid provider completes and signs the form (item 24). Items 8 to 10 identify the prescribing physician or practitioner, and items 16 to 18 carry the primary diagnosis and the justification for the service drawn from the prescriber's documentation.

Submitting and payment

How to submit it
The printed form directs mail to GMCF, Georgia Medicaid's former review vendor, so the paper route is legacy; fee-for-service PA requests are now normally entered on the GAMMIS web portal. Members in a Georgia Families CMO follow that plan's own prior authorization forms.
Who pays
Prior authorization is contingent on the member's Medicaid eligibility and the provider's enrollment at the time of service, and every request is subject to retrospective peer review.

Good to know

  • Check one service type at the top, DME, O&P or case management. The statement of services holds up to ten lines, each with procedure code, price per unit, months of units and units per claim.
  • The form's revision date is 07/10, and its diagnosis code box is still labeled ICD 9-CM.
  • Many equipment items also need an item-specific Certification of Medical Necessity; Georgia publishes about 20 of them, revised 06/2025, alongside the DMA 610.
  • Item 18 asks for the justification and circumstances for the requested services, and a separate page can be attached when more space is needed.

Get the official form

Download the current version from the source each time; forms change without notice.

Prior Authorization Request

Official pagePDF

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Where do I submit the Georgia DMA 610?

The form still prints a mailing address for GMCF, Georgia Medicaid's former utilization management vendor. Fee-for-service prior authorization requests are now normally entered on the GAMMIS web portal, and members enrolled in a Georgia Families care management organization use that plan's own prior authorization process and forms.

What services does the DMA 610 cover?

It is a fee-for-service prior authorization request for three service types, chosen by a checkbox at the top: durable medical equipment, orthotics and prosthetics, and case management. Other medical services use other Georgia Medicaid forms, such as the DMA-81 Prior Approval for Medical Services.