--- title: "Prior Authorization, Definition | MedTech Terms" description: "Payer requirement for approval before a service or device is covered. Plain-English Reimbursement definition for MedTech teams, with examples and related terms." lang: en json-ld: | { "@context": "https://schema.org", "@graph": [ { "@type": "DefinedTerm", "@id": "https://medtechterms.com/terms/prior-authorization#term", "name": "Prior Authorization", "description": "Prior authorization (PA) is a payer process requiring providers to obtain approval - based on medical necessity criteria - before a service, procedure, or device is covered. 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[Home](/) 2. / 3. [Terms](/terms) 4. / 5. [Reimbursement](/terms?cat=Reimbursement) 6. / 7. Prior Authorization [All terms](/terms) Reimbursement [Hospital Buyer & Reimbursement](/ecosystems/hospital-buyer) # Prior Authorization Payer requirement for approval before a service or device is covered. Reviewed by [Christian Espinosa, Founder, Blue Goat Cyber](/authors/christian-espinosa) Last reviewed May 5, 2026 ## Definition Prior authorization (PA) is a payer process requiring providers to obtain approval - based on medical necessity criteria - before a service, procedure, or device is covered. Common for high-cost devices, advanced imaging, and many [DTx](/terms/digital-therapeutics)/ [RPM](/terms/remote-patient-monitoring) services. ## What this means in practice PA is a major friction point for new technology adoption; clinical pathway and PA support tools are increasingly part of the manufacturer commercial model. Common pitfalls - • Underestimating PA denial rates and appeal timelines when modeling commercial uptake. ## Related terms Grouped by theme ### Reimbursement & Market Access · From this learning path [ Reimbursement Health Technology Assessment(HTA) Systematic evaluation of clinical and economic value of a health technology. Adjacent lesson ](/terms/hta?from=reimbursement-and-market-access)[ Reimbursement Transitional Coverage for Emerging Technologies(TCET) CMS pathway providing time-limited Medicare coverage for FDA-designated Breakthrough Devices. Adjacent lesson ](/terms/tcet?from=reimbursement-and-market-access)[ Reimbursement Budget Impact Model(BIM) Financial model that estimates the total cost consequences of adopting a new technology to a payer's budget over a defined horizon. ](/terms/budget-impact-model?from=reimbursement-and-market-access)[ Reimbursement CPT Codes(CPT) AMA-maintained codes that describe medical procedures and services. ](/terms/cpt-codes?from=reimbursement-and-market-access) ### More in Reimbursement · Same category [ Reimbursement Current Procedural Terminology Codes(CPT) AMA-maintained codes used to report medical procedures and services for billing. ](/terms/cpt)[ Reimbursement HCPCS Codes(HCPCS) CMS-maintained codes for products, supplies, and services not in CPT. ](/terms/hcpcs)[ Reimbursement ICD-10-CM / ICD-10-PCS Diagnosis (CM) and inpatient procedure (PCS) coding systems used in U.S. claims. ](/terms/icd-10)[ Reimbursement LCD and NCD Local and National Coverage Determinations from Medicare. ](/terms/lcd-ncd) Cited by Where this term appears across MedTech Terms. Learning paths (1) - [Reimbursement & Market Access](/paths/reimbursement-and-market-access)Lesson 10 of 14 Ecosystems (1) - [Hospital Buyer & Reimbursement](/ecosystems/hospital-buyer) ## Primary references 3 sources Link health: 3 verified · last checked 2026-06-20 CMS· 1 AMA· 1 AdvaMed· 1 1. [1 CMS PA reform Verified CMS · cms.gov ](https://www.cms.gov/) 2. [2 AMA CPT Resources Verified AMA · ama-assn.org ](https://www.ama-assn.org/practice-management/cpt) 3. [3 AdvaMed - Payment & Coverage Verified AdvaMed · advamed.org ](https://www.advamed.org/our-work/) Inline markers like \[1\] jump to the matching reference above. Sponsor note ### Need cybersecurity expertise on a connected-device launch? Blue Goat Cyber helps MedTech teams ship connected products that hospital security teams will actually procure. [Book a 30-minute discovery session](https://go.bluegoatcyber.com/meetings/blue-goat-cyber/discovery-session) - No obligation - Expert-led from minute one - NDA available on request MedTech Terms is a community resource sponsored by [Blue Goat Cyber](https://bluegoatcyber.com). Definitions are independent of any vendor. On this term Category Reimbursement Sources 3 Updated 5/5/2026 [Compare with another term](/compare?a=prior-authorization) Learn in 60 seconds Card Lesson Quiz Payer requirement for approval before a service or device is covered. - · PA is a major friction point for new technology adoption; clinical pathway and PA support tools are increasingly part of the manufacturer commercial model. - · Common for high-cost devices, advanced imaging, and many DTx/RPM services. Remember this Watch out: Underestimating PA denial rates and appeal timelines when modeling commercial uptake. You may also need Auto-suggested from Reimbursement and shared keywords. - [FedRAMP(FedRAMP) ](/terms/fedramp) - [HCPCS Codes(HCPCS) ](/terms/hcpcs) - [340B Drug Pricing Program(340B) ](/terms/340b) - [ASC Site-of-Service Shift ](/terms/asc-shift) - [Bundled Payment ](/terms/bundled-payment) - [CMS IDE Coverage (Category A & B) ](/terms/ide-coverage) [All Reimbursement terms](/terms?cat=Reimbursement) MedTech Terms An authoritative, plain-language reference for the regulatory, quality, cybersecurity, and software terms that shape modern medical devices. Browse - [All terms](/terms) - [A–Z index](/a-z) - [Categories](/categories) - [Ecosystems](/ecosystems) - [Learning paths](/paths) - [Compare terms](/compare) - [Quiz](/quiz) Resources - [FDA Medical Devices](https://www.fda.gov/medical-devices) - [EU MDR](https://eur-lex.europa.eu/eli/reg/2017/745/oj) - [IMDRF](https://www.imdrf.org/) - [Methodology](/methodology) - [Changelog](/changelog) - [Editor: Christian Espinosa](/authors/christian-espinosa) - [About this site](/about) © 2026 MedTech Terms. Reference content for educational purposes - not regulatory advice. A community resource sponsored by [Blue Goat Cyber](https://bluegoatcyber.com)