Georgia Medical Lien Law for Outpatient Providers (2026)

Georgia gives a statutory lien to physician practices and, since 2023, chiropractic practices, as well as hospitals, nursing homes and certain burn care practices. The lien only holds up if the practice follows strict notice, filing and health insurance steps. A 2025 law also changed how medical bills and letters of protection are treated in injury cases.

At a glance

Question	Answer
Statutory lien for outpatient providers	Yes, for physician practices and chiropractic practices, plus hospitals, nursing homes and traumatic burn care practices
Main law	O.C.G.A. §§ 44-14-470 to 44-14-477
What outpatient providers usually rely on	Physician and chiropractic practices can use the statutory lien. Letters of protection and written payment agreements are also used.
Notice or filing	Written notice at least 15 days before filing, by first-class and certified mail or statutory overnight delivery. Then a verified statement filed with the superior court clerk in the practice's county and the patient's county, within 90 days after the patient first sought treatment.
Limits on the amount	Reasonable charges. The lien is subject to any attorney's lien, and a chiropractic lien is also subject to any hospital lien. No percentage cap found in the statute.
Health insurance and billing the patient	The lien is unenforceable unless a claim was first submitted to each of the patient's health insurers and rejected. The lien is against the patient's claim, not the patient or the patient's property.
Billed vs. paid in the case	For claims arising on or after April 21, 2025, the jury hears both billed amounts and what the patient's health insurance would pay, whether or not the insurance was used.
Recent changes (2023–2026)	SB 168 (2023) added chiropractors and the health insurance claim rule. SB 68 (2025) added § 51-12-1.1. In re Ferguson (2026) addressed attorneys' duties on doctor's lien forms.

Is there a lien law for outpatient providers?

Yes. O.C.G.A. § 44-14-470(b) gives a lien for reasonable charges to any person, firm, hospital authority or corporation operating:

a hospital or nursing home;
a physician practice, meaning a practice with at least one Georgia-licensed physician;
a chiropractic practice, meaning a practice with at least one Georgia-licensed chiropractor;
a traumatic burn care medical practice, for burn care charges over $50,000 from a single accident.

Physical therapy practices, imaging centers and surgery centers are not named as separate categories.

The lien attaches only to the injured person's legal claims arising from the injury. It is not a lien on the patient or the patient's other property, and it is not evidence that the patient failed to pay a debt. The lien law does not apply to money due under Georgia's workers' compensation law (§ 44-14-474).

Chiropractic practices were added by SB 168 in 2023. The Georgia Supreme Court confirmed that before 2023, Georgia lien law did not give chiropractors lien rights (In re Ferguson, 324 Ga. 222 (2026)). Georgia courts require strict compliance with the steps to create and perfect these liens (Med-Care Solutions, LLC v. Bey & Associates, LLC, 362 Ga. App. 861 (2022), as quoted in Ferguson).

How a lien is perfected

Under O.C.G.A. § 44-14-471, as rewritten in 2023:

Send written notice first. At least 15 days before filing, notice goes to the patient and, as far as the provider knows, to the parties the patient claims are liable and their insurers. It must state that the lien is not a lien against the patient or the patient's property and is not evidence of failure to pay a debt. It must be sent by first-class and certified mail, or by statutory overnight delivery, return receipt requested.
File a verified statement with the superior court clerk in the county where the practice is located, and in the county where the patient lives if the patient is a Georgia resident. The statement lists the patient's name and address, the practice name and location, the operator's name and address, the dates of treatment and the amount claimed.
Meet the filing deadline. Physician and chiropractic practices file within 90 days after the patient first sought treatment from the practice for the injury. Hospitals, nursing homes and burn care practices file within 75 days after discharge.
Submit a claim to health insurance. The lien is not enforceable unless the provider first submitted a claim to each of the patient's health insurers, if any, and the claim was rejected (§ 44-14-471(c)).

Late or missing notice or filing invalidates the lien. The only exception is against a liable party that actually received the notice and filed statement, by hand delivery, certified mail or statutory overnight delivery, before any release or settlement (§ 44-14-471(b)).

Settlements and enforcement:

A release or covenant not to sue does not defeat a perfected lien unless the lienholder joins in it or consents (§ 44-14-473).
A settling party that first gets the patient's sworn statement that all covered bills are paid is protected, unless the lien is already on file in the county named in that statement. A false statement is false swearing (§ 44-14-477).
To enforce an unpaid lien, the provider sues the liable party or its insurer within one year after liability is finally determined by settlement, release, covenant or judgment. The court may award attorney's fees if the provider wins (§ 44-14-473(a)). The lien gives no separate right to sue over who caused the injury (§ 44-14-476).

Limits on what the provider is paid

The lien covers reasonable charges. It is subject to any attorney's lien, and a chiropractic lien is also subject to any hospital lien (§ 44-14-470(b)). We found no percentage-of-recovery cap or pro rata reduction rule in §§ 44-14-470 to 44-14-477.

Lien agreements and letters of protection

O.C.G.A. § 51-12-1.1(d), added by SB 68 in 2025, covers any letter of protection or other arrangement where a provider treats in exchange for payment from a judgment or settlement, however it is described. For those claims, the following are relevant and discoverable:

a copy of the letter of protection;
all charges, itemized and coded;
if the provider sold the bill for less than the invoice amount, the buyer's name and the price paid;
whether the patient was referred for treatment under a letter of protection, and by whom.

This section applies only to claims arising on or after April 21, 2025, the date SB 68 was signed and took effect.

In In re Ferguson (Apr. 21, 2026), a patient and attorney both signed a chiropractor's "Notice of Doctor's Lien" directing the attorney to pay the doctor from the settlement. The attorney did not pay. The Georgia Supreme Court held the State Bar had not proved a rule violation: read in context, the attorney could reasonably conclude the form was an attempted statutory lien that was never perfected, and in 2017 could not have been. That gave him a valid defense. The Court noted the argument that a letter of protection is a separate agreement, and expressly left open whether the form created only a lien-secured obligation.

The attorney's duty to pay the provider

Georgia Rule of Professional Conduct 1.15(I)(b), as quoted in Ferguson, says a lawyer may not disregard a known third-party interest in funds the lawyer holds if it is based on:

a statutory lien;
a final judgment; or
a written agreement by the client, or the lawyer on behalf of the client, guaranteeing payment out of those funds.

The lawyer may disregard the interest if the lawyer reasonably concludes there is a valid defense. The maximum penalty is disbarment. Rule 1.15(I)(c) and (d) require the lawyer to promptly notify and pay the third person and to keep any disputed portion separate until it is resolved.

In In re Tyson (Ga. Feb. 18, 2025), the Court accepted a two-year suspension where the lawyer, among other violations, failed to notify or pay a chiropractor with an interest in settlement funds.

Enforcement of the statutory lien itself runs against the liable party and its insurer (§ 44-14-473(a)), not against the patient's attorney.

Health insurance, no-fault and billing the patient

Health insurance first for the statutory lien. The lien is unenforceable unless the provider first submitted a claim to each of the patient's health insurers and the claim was rejected (§ 44-14-471(c)).
Insurance rates reach the jury. For claims arising on or after April 21, 2025, if the patient has health insurance, the jury may hear what the insurer would pay, whether or not the insurance was used (§ 51-12-1.1(c)).
Not a lien on the patient. The statutory lien is against the patient's legal claim only, not the patient or the patient's property (§ 44-14-470(b)).

We could not confirm a rule in a primary source on whether a provider can collect the unpaid balance from the patient after a lost or small case.

Billed vs. paid medical damages

For claims arising on or after April 21, 2025, O.C.G.A. § 51-12-1.1 provides:

Medical expense damages are recoverable only as the section provides, and are limited to the reasonable value of medically necessary care, as decided by the jury or judge.
If the patient has health insurance or governmental workers' compensation, the evidence includes both the amounts charged and the amounts actually needed to satisfy those charges under the insurance or program, whether or not it was used.
The common-law collateral source rule is set aside to the extent needed to admit this evidence. Courts may give clarifying jury instructions.
Either side may still challenge whether charges were reasonable and the care medically necessary.

Claims that arose before April 21, 2025 are governed by prior law (SB 68 § 9(b)).

Recent changes

SB 168 (2023) rewrote the medical lien statutes. It added chiropractic practices as lienholders, ranked below hospital liens; added the rule that a health insurance claim must be submitted and rejected; and applied the physician practice timing rules to chiropractors.
SB 68 (2025), signed and effective April 21, 2025, added § 51-12-1.1 on medical damages and letter of protection discovery. It also limited arguments anchoring noneconomic damages, paused discovery while a motion to dismiss is pending, limited voluntary dismissals, allowed seat-belt evidence, changed negligent security law and allowed bifurcated trials. The negligent security and § 51-12-1.1 changes apply only to claims arising on or after the effective date. The rest applies to pending cases.
In re Ferguson, 324 Ga. 222 (Apr. 21, 2026) addressed attorneys' duties when a patient and attorney sign a doctor's lien form.

What this means for your practice

For physician and chiropractic practices, the statutory lien depends on every step: notice by first-class and certified mail (or statutory overnight delivery) at least 15 days before filing, and a filing in both the practice's county and the patient's county within 90 days of the first visit. A missed step can invalidate the lien.
The lien cannot be enforced without a claim first submitted to the patient's health insurer and rejected, so the claim and the denial are part of the lien file.
Ferguson shows that a form titled as a lien can be read as an attempted statutory lien. Rule 1.15(I)(b) separately protects a written agreement by the client or the lawyer guaranteeing payment out of the settlement funds.
For claims arising on or after April 21, 2025, the letter of protection, itemized and coded bills, any sale of the bill and the referral source are discoverable, and insured patients' damages are weighed against insurer rates.
If a perfected lien is not paid, the provider has one year after the case is resolved to sue the liable party or its insurer (§ 44-14-473(a)).

Sources

How we verified: the as-passed texts of SB 168 (2023) and SB 68 (2025) were read in full, and O.C.G.A. §§ 44-14-470(b) and 44-14-471(a) and (c) were checked against the 2025 Georgia Code on Justia.