Which item is sometimes required by some payers before a procedure is performed?

• A. Preauthorization form
• B. Prior approval letter
• C. Precertification
• D. Consent form

Answer: (A)

Before a procedure, some payers require authorization to confirm medical necessity and coverage. The preauthorization form is the document used to request that approval. It gathers essential details—patient and provider information, the planned procedure’s CPT codes, diagnosis, and a justification for why the procedure is medically necessary. When the payer approves, the procedure is authorized for billing under coverage; if not approved, the provider may need to pursue alternatives or raise the request again with additional information. Some payers use different terms for the same process, like precertification or prior authorization, or may issue a prior approval letter after reviewing the case. A consent form, by contrast, records the patient’s agreement to undergo the procedure, not payer authorization.