Authorization Units vs Visits: Tracking Therapy Approvals
By George Ruan • October 7, 2026
Last reviewed: October 7, 2026.
Check what the approval counts before you count against it. Authorization requests are filed with a quantity type, usually visits, units or days, and the approval comes back with that quantity, the approved codes, and a start and end date. For most outpatient therapy approvals we work, the quantity is visits, and each attended session in the window uses one. Do not assume “12 units” means 12 appointments until the approval says what a unit is.
Sections
Three numbers, not one
Every therapy authorization we track carries three limits, and the first one to run out ends coverage:
Quantity: the approved visits (or units or days), and the codes they apply to. A request for weekly 90837 sessions is approved for 90837, not for every psychotherapy code.
Date window: the effective-from and effective-to dates. Unused visits do not carry past the end date.
Who and where: the rendering clinician, billing provider and, sometimes, the service location the approval names.
Remaining visits should be counted live against attended sessions inside the window. A canceled or no-show appointment normally does not use a visit, which is why we reconcile the authorization against the EHR’s attended dates rather than the schedule.
What we see go wrong
Counting from the wrong list. Session forms and invoices sometimes list a canceled date instead of the rescheduled visit that actually happened. We check every listed date against the attended appointments before anything is submitted.
Trusting an old notice. The current authorization in the payer portal, with its own approved and used counts, is the record to read, not last year’s approval email or an expired row that still shows visits left.
Watching only the visit count. Practices tend to notice when visits run low, but many approvals lapse on their end date with visits still unused. Calendar-driven renewals catch those.
Several approvals expiring together. When one plan approves a group of clients on a similar cycle, renewals pile up in the same month. A list of clients by expiration date lets the biller start each reauthorization before the window closes rather than after.
As a software example, EZClaim’s authorization documentation distinguishes unit tracking from visit tracking, and Stride’s expiring-authorizations report is driven by end dates rather than remaining quantity. Whatever tool you use, check how it counts before trusting its balance.
When the payer and your EHR disagree
Pull the current authorization and its approved and used counts from the payer.
List attended sessions in the window by date, code and clinician from the EHR.
Look for sessions billed under a different code than the one approved, another clinician’s visits on the same authorization, and duplicate or corrected claims.
Where the portal links claims to the authorization, open the exact service date to confirm what was counted and paid.
If the gap is real, request a renewal or an extension before the next session, with updated clinical notes from the treating clinician.
Keep clinical decisions with the clinician. The billing job is to show what the approval supports and flag the renewal early, not to fit treatment to the remaining number. For the difference between this approval and a referral, see therapy referral versus prior authorization.
Frequently Asked Questions
Does a canceled session use up an authorized visit?
Normally no; the count is of attended, billed sessions in the window. Confirm against the payer’s used count if the numbers do not match.
Can we keep using leftover visits after the end date?
No. Ask for an extension or a new authorization before the window closes, and treat later sessions as unauthorized until it is approved.
How early should a reauthorization start?
Early enough that the clinician can supply updated notes and the payer can decide before the last approved visit or the end date, whichever comes first. Review timelines vary by payer.
Sources
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About Bomi
Founded by George Ruan, Dax Earl, and Andrey Goder, Bomi helps independent therapists and group practices with insurance billing, credentialing, and payer follow-up. Bomi grew out of Dax’s experience helping his mother with her therapy practice, with a clear purpose: reduce the administrative burden of insurance while keeping practice owners in control.
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