Macleod will start at number eight alongside blind-side flanker Jac Morgan, who came on as a replacement in the 20-13 victory over Argentina last weekend, and captain Justin Tipuric.
Wing Josh Adams returns to the side after missing the games against New Zealand and Argentina with injury.
The Welsh front row remains unchanged.
Owen Watkin has stepped up from the bench and will start alongside George North in the centre.
On Macleod's selection, Pivac said: "He's been really unfortunate in the past. We've wanted to use him on a couple of occasions, so this is very much third time lucky for him.
"He covers the back row. We know a lot about him, I've coached him at the Scarlets. He brings a lot of energy, he's very strong over the ball and in tandem with Jac Morgan hopefully, that will be a strong part of our game."
Pivac said he expected Georgia to pose a similar challenge to Argentina and said his selections were made with one eye on the next game against Australia.
"The spine of the team is there. It's very much about the here and now, we've got a game to play against Georgia and we have to be successful. But there's also an eye to the Australia match," he said.
"We need to back up the performance against Argentina, be a lot more clinical with the ball."
Two more players could make their senior international debuts off the bench with Exeter's teenage lock Dafydd Jenkins and Dane Blacker in the squad.
"Daf captained (Exeter) last week so his leadership is valued and already in camp for a very short time he's picked everything up very quickly," Pivac said. "We're excited to see him go. There's not many players like him in Wales."
Team:
15 - Louis Rees-Zammit, 14 - Alex Cuthbert, 13 - George North, 12 - Owen Watkin, 11 - Josh Adams, 10 - Rhys Priestland, 9 - Tomos Williams, 8 - Josh Macleod, 7 - Justin Tipuric (captain), 6 - Jac Morgan, 5 - Adam Beard, 4 - Ben Carter, 3 - Dillon Lewis, 2 - Ken Owens, 1 - Gareth Thomas.
Replacements: 16 - Bradley Roberts, 17 - Rhodri Jones, 18 - Sam Wainwright, 19 - Dafydd Jenkins, 20 - Taulupe Faletau, 21 - Dane Blacker, 22 - Sam Costelow, 23 - Leigh Halfpenny
Two changes for Georgia team
Georgia have recalled number eight Tornike Jalaghonia and wing Mirian Modebadze for the match.
Georgia are hoping to bounce back from a narrow 20-19 loss to Samoa in Tbilisi last weekend and coach Levan Maisashvili has largely stuck with the same line-up.
Modebadze comes into the starting team for Aka Tabutsadze, who was concussed against the Pacific islanders, while the selection of Jalaghonia has forced a shuffle in the back row of the scrum.
Otar Giorgadze drops out of the team and Beka Gorgadze moves from the back of the scrum to flanker to accommodate the number eight.
"Wales will play against us with a strong line-up, which is a sign of respect from their side," Maisashvili told the Georgia Rugby Union website. "They expect a strong resistance from us, which is an honour and an opportunity for us.
"Unfortunately, we lost several players due to injuries, and several could not train fully. Nevertheless, I think we are ready for the game and we are looking forward to it."
Georgia started the autumn series with a 34-18 win over Uruguay. They have lost all three previous meetings with Wales, the last of which was an 18-0 defeat in 2020.
Team:
15-Davit Niniashvili, 14-Mirian Modebadze, 13-Deme Tafladze, 12-Merab Sharikadze, 11-Sandro Todua, 10-Tedo Abzhandadze, 9-Vasil Lobzhanidze, 8-Tornike Jalaghonia, 7-Beka Gorgadze, 6-Beka Saghinadze, 5-Kote Mikoutadze, 4-Nodar Cheishvili, 3-Guram Papidze, 2-Giorgi Chakoidze, 1-Guram Gogichashvili
Replacements: 16-Shalva Mamukashvili, 17-Nika Abuladze, 18-Aleksandre Kuntelia, 19-Lado Chachanidze, 20-Sandro Mamamvarishvili, 21-Luka Matkava, 22-Lasha Khmaladze, 23-Lasha Lomidze.
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