Reference
Prior authorization statistics (2026)
The numbers behind the prior authorization burden: how often PAs are denied, how often denials are overturned on appeal, how few are actually appealed, and the time it costs practices. Every figure below carries its source.
General reference, not a coverage determination or legal/medical advice. Figures vary by payer, specialty, and year.
Common questions
What is the prior authorization denial rate?
There is no single national prior authorization denial rate. The widely cited ~11.8% figure (Kodiak Solutions, 2024) is an all-claims initial denial rate, not PA-specific. For prior authorization on procedures, rates are commonly higher: orthopedic ambulatory surgery centers often run 14–22% and interventional pain procedures around 20% (industry revenue-cycle data). Actual rates vary widely by payer, specialty, and documentation quality.
How many prior authorization denials are overturned on appeal?
The AMA reports 81.7% of appealed prior authorization denials are fully or partially overturned. The catch is that most denials are never appealed — fewer than 1 in 5 physicians (about 18%) say they always appeal — so many overturnable denials are written off instead of pursued.
How much time does prior authorization take?
Practices complete roughly 39 prior authorizations per physician per week, and physicians and their staff spend about 13 hours per week on prior authorization (AMA Prior Authorization Physician Survey). That staffing cost is a big reason most denials go unappealed.
Why are so few prior authorization denials appealed?
Appeals take time a busy practice does not have. With around 39 PAs per physician each week and roughly 13 hours of staff time already spent, drafting a policy-grounded appeal for every denial is rarely feasible — so denials that would likely be overturned are abandoned.
What does unmanaged prior authorization cost a practice?
It depends on PA volume, denial rate, and revenue per procedure: the revenue at risk is roughly the denied authorizations that are never appealed, multiplied by the revenue per procedure, over a year. You can model your own number with the revenue-at-risk calculator and see a worked value case by specialty.
Put these numbers to work
Model the revenue at risk for your own practice with the revenue-at-risk calculator, see a worked value case by specialty, or browse prior authorization requirements by payer and procedure and state prior authorization laws.
Weighing whether to act on these numbers? See should a small practice pilot an AI prior authorization tool and how Praxigen compares to manual and payer-side approaches.
- 81.7% of appealed PA denials are overturned — AMA Prior Authorization Physician Survey
- ~18% of physicians always appeal a denial — AMA Prior Authorization Physician Survey (2024)
- 14–22% PA denial rate, procedural specialties — Orthopedic ASC 14–22%; interventional pain ~20% (industry RCM data, 2024)
- ~11.8% all-claims initial denial rate (2024) — Kodiak Solutions revenue-cycle data, ~2,100 hospitals / 300,000 physicians (2024)
- ~39 prior auths per physician, per week — AMA Prior Authorization Physician Survey (2024)
- ~13 hrs physician + staff time on PA, per week — AMA Prior Authorization Physician Survey (2024)