Prior Authorization Statistics (2026): The Real Cost of the Approval Process
Prior authorization has become one of the heaviest administrative loads in American healthcare, and the data shows it falls hardest on the clinics and staff trying to get patients care. The numbers below come from the AMA, KFF, CAQH, HHS Inspector General, CMS, GAO, and peer-reviewed research. They cover how much time and money prior authorization consumes, how often it delays or denies care, and what the 2026 federal reforms are meant to change.
Every number here comes from a named source: a government agency, a research body, or a peer-reviewed study, 10 in all. Use any of them, just credit the original source.
The administrative load on practices
The average physician submits around 40 prior authorization requests per week, consuming roughly 13 hours of physician and staff time, more than a full business day and a half that cannot be spent on patients. The burden has grown large enough that 40% of physician practices now employ staff dedicated exclusively to this task, and 92% of medical group practices have hired or reassigned staff just to keep up with the volume. A single request often touches three or more employees, and more than a third of practices spend upward of 35 minutes completing one. Behavioral health providers and specialists feel the weight most acutely, spending an average of 25 minutes obtaining an authorization by phone or fax, compared with 14 minutes for generalists. Across the care team, billing specialists alone log a median of 9 hours per week on prior authorization, with practice managers and registered nurses each spending additional hours on top of that.
40 PAs per physician, per week
Physicians complete an average of 40 prior authorization requests per physician each week, a pace that leaves practices little capacity to manage the volume without dedicated administrative staff.
Source:American Medical Association, 202513 hours a week
Prior authorization consumes an average of 13 hours of physician and staff time each week, the equivalent of more than 1.5 full business days.
Source:American Medical Association, 202540% hire staff just for PA
Two in five physicians (40%) employ staff dedicated exclusively to prior authorization tasks.
Source:American Medical Association, 202592% added or reassigned staff
92% of surveyed medical group practices reported hiring or reassigning staff solely to handle the growing volume of prior authorization requests.
Source:Medical Group Management Association, 20253+ employees per request
60% of practices indicated that at least three employees are typically involved in completing a single prior authorization request.
Source:Medical Group Management Association, 202535+ minutes per request
35% of medical group practices reported spending upwards of 35 minutes on average per prior authorization request.
Source:Medical Group Management Association, 202525 vs 14 minutes
Behavioral health providers and specialists spend an average of 25 minutes obtaining a prior authorization via phone, fax, or email, compared with 14 minutes for generalists.
Source:CAQH, 20249 hours a week on billing staff
Billing and coding specialists at physician practices spend a median of 9 hours per week on prior authorization, practice managers spend 5 hours, and registered nurses spend 2.5 hours.
Source:Health Affairs Scholar, 2024What it costs
Prior authorization accounts for an estimated $35 billion of U.S. health care administrative spending each year. A large share of that cost traces to process inefficiency. A manual prior authorization costs providers an average of $10.97 per transaction, while a fully electronic one costs $5.79, roughly half as much. The gap is even wider on the payer side, where manual processing runs $3.52 per request compared to just five cents for a fully electronic transaction. CAQH estimates that moving all medical prior authorization to fully electronic workflows would save the industry $494 million a year, and CMS projects its 2024 Interoperability and Prior Authorization Final Rule will generate approximately $15 billion in savings over ten years. The difference between what the industry spends today and what it could spend is largely a function of how information moves, or fails to.
$35 billion a year
Prior authorization is estimated to account for $35 billion of total U.S. health care administrative spending annually.
Source:Health Affairs Scholar, 2024$10.97 vs $5.79 per request
A manual prior authorization costs providers an average of $10.97 per transaction, while a fully electronic one costs $5.79, roughly half the manual cost.
Source:CAQH, 2024$3.52 vs a nickel
On the payer side the gap is even starker: a manual prior authorization costs a health plan $3.52 per transaction, while a fully electronic one costs just $0.05.
Source:CAQH, 2024$494 million in savings
If all medical prior authorization transactions were fully electronic, CAQH estimates the industry would save $494 million annually.
Source:CAQH, 2024~$15 billion over 10 years
CMS estimates its 2024 Interoperability and Prior Authorization Final Rule, which mandates electronic prior authorization APIs, will generate approximately $15 billion in savings over ten years.
Source:Centers for Medicare and Medicaid Services, 2024Volume and denials in Medicare Advantage
Medicare Advantage insurers received nearly 53 million prior authorization requests in 2024, up from 49.8 million the year before, and denied 4.1 million of them, a denial rate of 7.7% compared to 6.4% in 2023. Only 11.5% of those denials were appealed, meaning the vast majority of patients whose care was denied never challenged the decision. Among those who did appeal, more than 80% were overturned, including 95% of skilled nursing facility denials, a figure that reached 97% for one contractor. For inpatient rehabilitation facilities, overturn rates ranged from 14% to 86% depending on the insurer, with the largest plans denying admissions at some of the highest rates. A separate federal review found that 13% of denied Medicare Advantage requests actually met Medicare coverage rules and would likely have been approved under traditional Medicare, suggesting a meaningful share of denials reflect plan policy rather than clinical necessity.
53 million requests
Nearly 53 million prior authorization requests were submitted to Medicare Advantage insurers in 2024, up from 49.8 million in 2023.
Source:KFF, 20264.1 million denials (7.7%)
Medicare Advantage insurers fully or partially denied 4.1 million prior authorization requests in 2024, or 7.7% of those submitted, up from a 6.4% denial rate in 2023.
Source:KFF, 2026Only 11.5% appealed
Just 11.5% of denied Medicare Advantage prior authorization requests were appealed in 2024, up from 7.5% in 2019, meaning most patients whose care was denied never challenged the decision.
Source:KFF, 202680.7% overturned on appeal
More than 80% of appealed Medicare Advantage prior authorization denials were overturned in 2024, representing care that was ordered by a provider and ultimately deemed necessary but potentially delayed.
Source:KFF, 202695% of SNF denials reversed
When skilled nursing facility prior authorization denials were appealed, Medicare Advantage organizations overturned 95% of them in favor of the enrollee, with one contractor (naviHealth) reaching a 97% overturn rate.
Source:HHS Office of Inspector General, 202613% met coverage rules
13% of prior authorization requests denied by Medicare Advantage organizations actually met Medicare coverage rules, meaning those services likely would have been approved under traditional Medicare.
Source:HHS Office of Inspector General, 202214% to 86% by plan
Inpatient rehabilitation facility prior authorization denial overturn rates ranged from 14% to 86% across Medicare Advantage organizations on appeal, with the three largest insurers denying these admissions at some of the highest rates.
Source:HHS Office of Inspector General, 2026The toll on patients
Ninety-five percent of physicians say prior authorization delays access to necessary care, and 92% say it negatively affects clinical outcomes. Nearly four in five report that patients abandon treatment altogether because of the process. More than one in four physicians have seen prior authorization contribute to a serious adverse event, including hospitalization, permanent impairment, or death. A Johns Hopkins systematic review of 25 studies found the process associated with measurable harm, including care delays, disease exacerbation, preventable hospitalizations, and lower rates of disease-free survival. Patients themselves reflect this picture, since 47% of insured adults who went through a prior authorization in the past two years found it somewhat or very difficult to navigate, and 48% said their insurer delayed their ability to receive a service, treatment, or medication.
95% say care is delayed
More than nine in 10 physicians (95%) say prior authorization delays access to necessary care.
Source:American Medical Association, 202579% see patients abandon care
Nearly four in five physicians (79%) report that patients abandon treatment due to prior authorization challenges.
Source:American Medical Association, 202526% report serious harm
More than one in four physicians (26%) report that prior authorization has led to a serious adverse event, including hospitalization, permanent impairment, or death.
Source:American Medical Association, 202592% see worse outcomes
More than nine in 10 physicians (92%) say prior authorization negatively affects patient clinical outcomes.
Source:American Medical Association, 2025Harm across 25 studies
A Johns Hopkins systematic review of 25 studies, published in The American Journal of Medicine, found prior authorization associated with measurable patient harm including care delays, disease exacerbation, preventable hospitalizations, and lower rates of disease-free survival.
Source:American Journal of Medicine, 202547% found it difficult
Almost half (47%) of insured adults who went through a prior authorization in the past two years found it somewhat or very difficult to navigate.
Source:KFF, 202548% faced a care delay
Among insured adults who experienced a prior authorization, 48% said their insurer delayed their ability to get a service, treatment, or medication.
Source:KFF, 2025Cancer and specialty care
Prior authorization touches radiation oncology at a scale that directly disrupts treatment timelines, with 92% of radiation oncologists reporting it causes treatment delays, affecting an average of 35% of their patients. More than two-thirds say those delays typically last five days or more. Nearly a third have seen patients sent to the emergency room, hospitalized, or permanently disabled as a result, and 7% report it contributed to a patient's death. One in three radiation oncologists say patients abandoned radiation treatment because of prior authorization hurdles. Behavioral health access faces structural gaps as well, with eight of nine large Medicare Advantage organizations requiring prior authorization for behavioral health services, a category CMS has not yet targeted in its prior authorization audits.
92% see treatment delays
Nearly all radiation oncologists (92%) report that prior authorization causes treatment delays, with delays occurring for 35% of their patients on average.
Source:American Society for Radiation Oncology, 202468% wait 5+ days
More than two-thirds of radiation oncologists (68%) say the average prior authorization delay lasts five days or more.
Source:American Society for Radiation Oncology, 202430% report serious events
Nearly a third of radiation oncologists (30%) report that prior authorization has caused emergency room visits, hospitalization, or permanent disability for their patients, with 7% reporting it led to or contributed to a patient's death.
Source:American Society for Radiation Oncology, 20241 in 3 see patients quit
One-third of radiation oncologists (33%) report that patients abandoned their radiation treatment due to prior authorization, with an average of roughly 1 in 10 of each physician's patients leaving treatment.
Source:American Society for Radiation Oncology, 20248 of 9 plans gate behavioral health
Eight of nine large Medicare Advantage organizations reviewed required prior authorization for behavioral health services, yet CMS has not targeted behavioral health in its prior authorization audits.
Source:U.S. Government Accountability Office, 2025Clinician burnout and the road ahead
Ninety-four percent of physicians say prior authorization contributes to burnout, and 74% report that denial rates have increased over the past five years, compressing both morale and capacity at the same time. Despite growing pressure on the industry to reform, only one in three physicians believes the latest insurer pledge to make meaningful changes will actually deliver results. On the regulatory side, CMS has set new response-time requirements under its 2024 Interoperability and Prior Authorization Final Rule. Medicare Advantage and Medicaid managed care plans must respond to expedited requests within 72 hours and standard requests within 7 calendar days, effective January 1, 2026. Whether those timelines close the gap between current denial practices and actual clinical standards remains to be seen, and the structural conditions that created the backlog, paper-heavy workflows, fragmented data, and staffing stretched thin, are still very much in place.
94% link it to burnout
More than nine in 10 physicians (94%) say prior authorization contributes to burnout.
Source:American Medical Association, 202574% see rising denials
Three-quarters of physicians (74%) report that prior authorization denial rates have increased over the past five years.
Source:American Medical Association, 2025Only 33% trust the pledges
Only one in three physicians (33%) believe the latest insurer pledge to reform prior authorization will make a meaningful difference.
Source:American Medical Association, 202572 hours / 7 days
Under the CMS Interoperability and Prior Authorization Final Rule, Medicare Advantage and Medicaid managed care plans must respond to expedited requests within 72 hours and standard requests within 7 calendar days, effective January 1, 2026.
Source:Centers for Medicare and Medicaid Services, 2024Curious where this is costing your clinic?
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