Georgia's workers' compensation law does not require advance authorization for an injured employee's treatment or testing, but an authorized medical provider can request it on this Board form. The provider completes Sections 1 and 2 and faxes or emails them, with supporting medical documentation, to the insurer or self-insurer. If the insurer does not respond in Section 3 within 5 business days, the requested treatment or testing stands pre-approved.
The authorized requesting medical provider completes Section 1 (identifying information) and Section 2 (diagnosis, ICD-10 and CPT/DRG codes, the treatment or testing, who will provide it and why), then certifies how and when it was sent and signs. The insurer or self-insurer's representative completes Section 3, the response.
The top of the form restates the Board's standing order: advance authorization is not required for payment, but an authorized provider may request it by completing Sections 1 and 2 and faxing or emailing them to the insurer or self-insurer. The insurer has 5 business days from receipt to respond in Section 3, after which the treatment or testing stands pre-approved.
Enter the patient's last name, first name, middle initial and date of injury, the employer name, the adjuster, and the insurer or self-insurer's name, email, phone and fax. The insurer's fax number or email address is where the form must go, and the 5-day clock runs from the insurer's receipt, so confirm the adjuster's current contact details before sending.
List the diagnosis with its ICD-10 code, the requested treatment or testing with its CPT or DRG code, who is to provide it, and the reason for it. Then fill in the requesting authorized provider's address, phone, fax and email. Board Rule 205 says to send supporting medical documentation with the form, which lets the insurer see that the request is related to the injury and reasonably required.
Check whether the form was faxed or emailed, enter the day, month and year it was sent, and sign as the authorized requesting medical provider. This certification is the provider's record of when the request went out, which matters if the insurer misses the 5 business day deadline and the treatment stands pre-approved.
The insurer or self-insurer checks whether the treatment or testing is authorized and, if not, why: not related to the on-the-job injury; not reasonably required to effect a cure, give relief or restore suitable employment; not provided by an authorized, panel or referral provider; additional information needed; or other. It certifies the date it faxed or emailed the response to you and signs.
If the insurer gives an initial written refusal within 5 business days, it must, within 21 days of first receiving the request, either authorize the treatment or testing in writing or file Form WC-3 with the Board stating specific grounds for controverting it. Advance authorization in a Board-approved WC/MCO may be governed by the plan contract instead.
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Request for Authorization of Treatment or Testing by Authorized Medical Provider
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
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If the insurer or self-insurer does not complete Section 3 and return it within 5 business days of receiving the form, the requested treatment or testing stands pre-approved. Under Board Rule 205, an employer that fails to follow this procedure must pay for the requested treatment or test related to the compensable injury. Your certification in Section 2 records the date you faxed or emailed it.
No. The Georgia Workers' Compensation Act does not require advance authorization as a condition for payment of services. The WC-205 is optional and lets an authorized provider get a decision before treating. A Board-certified WC/MCO may require pre-certification by contract with its network providers, so network providers should check their plan's rules.
No. Neither the request nor the insurer's response is filed with the Board unless the Board asks for it. The form goes directly to the insurer or self-insurer by fax or email, and the response comes back directly to the requesting authorized medical provider by fax or email.