All terms
ReimbursementHospital Buyer & Reimbursement
Prior Authorization
Payer requirement for approval before a service or device is covered.
Reviewed by Christian Espinosa, Founder, Blue Goat CyberLast 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/RPM 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
Shared paths + categoryReimbursement
Health Technology Assessment(HTA)
Systematic evaluation of clinical and economic value of a health technology.
Reimbursement & Market Access · adjacent
Reimbursement
Transitional Coverage for Emerging Technologies(TCET)
CMS pathway providing time-limited Medicare coverage for FDA-designated Breakthrough Devices.
Reimbursement & Market Access · adjacent
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.
Reimbursement & Market Access
Reimbursement
CPT Codes(CPT)
AMA-maintained codes that describe medical procedures and services.
Reimbursement & Market Access
Reimbursement
Current Procedural Terminology Codes(CPT)
AMA-maintained codes used to report medical procedures and services for billing.
Reimbursement & Market Access
Reimbursement
HCPCS Codes(HCPCS)
CMS-maintained codes for products, supplies, and services not in CPT.
Reimbursement & Market Access
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Primary references
3 sourcesLink health: 3 verified· last checked 2026-06-20
CMS·1AMA·1AdvaMed·1
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