Prior Authorisation
Also written as: PA — Prior Authorisation
A payer-required approval process that must be completed before an orthotic device is dispensed in order to confirm coverage and medical necessity.
Full Definition
Prior authorization (PA) is an administrative procedure mandated by insurance payers and managed care organizations requiring the treating clinician or orthotist to submit clinical documentation—such as the physician's prescription, diagnostic imaging, and a letter of medical necessity—before the device is fitted or billed. In orthotics, PA is commonly required for custom-fabricated devices, powered orthoses, and high-cost spinal braces. Editors reviewing PA request letters must verify that medical necessity language aligns with payer criteria, that ICD-10 diagnosis codes are accurate, and that HCPCS device codes are correctly specified. 'Prior authorization' is the preferred spelling in US English; 'prior authorization' follows UK/Australian English. Note both spellings exist in orthotics literature.
Usage
Usage note: In US English, spell as 'prior authorization.' In UK/Australian English, 'authorization.' Confirm client style before editing. Define 'PA' on first use in all documents.
In Context
- "The orthotist submitted the prior authorization request with supporting biomechanical evaluation and physician's prescription before ordering the KAFO components." — Insurance prior authorization letter
- "US documents use 'prior authorization' (z-spelling); editors working on international insurance documents should apply 'authorization' per the client's style guide." — Editorial style note