Items 1A to 5: authorization header
Date of issue, issuing office, the Veteran's name, the name of the physician or facility, the Veteran's claim number, Social Security number and the dates the authorization is valid from and to.
10-7078
Authorization and Invoice for Medical and Hospital Services
- Agency
- VA
- Revision
- February 2005
- Fillable fields
- 136
- Pages
- 2
- Official source
- VA form page
- Checked
- October 20, 2026
VA Form 10-7078: Authorization and Invoice for Medical and Hospital Services
VA Form 10-7078 is the Authorization and Invoice for Medical and Hospital Services from the U.S. Department of Veterans Affairs, listed on VA's page under the Veterans Health Administration (VHA). The form says its purpose is to authorize medical treatment and provide a means to bill for this service, although private providers may also use local billing forms or UB (Uniform Billing) Forms 92. It is collected under the authority of Title 38 1703, 1725 and 1728.
A VA issuing office completes Part I to authorize services for a named Veteran for a set period. The physician or facility furnishing the service completes Part II, the invoice. Parts III and IV are for VA use only. The reverse continues the invoice and prints the special provisions that govern acceptance of the authorization. The form notes that its instructions are written for a multi-part form.
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What's on VA Form 10-7078
Part I: services authorized
Item 6 lists the services authorized for the period in Item 5, with Item 7 fee, Item 8 fee schedule or contract, Item 9 authority, Item 10 estimated amount, Item 11 fiscal symbols and Item 12 authorized by, with name and title.
Part II: invoice
Dates of service by month, day and year, a description of each service, the fee claimed, the provider's Social Security or employer ID number, the billing date and the total claimed in Item 17.
Part III: for VA use only
An administrative certification that payment will not cause the payee to exceed the maximum amount allowed and that services were furnished as authorized or medically approved, with amount due, remarks, signature and an audit block.
Part IV and the reverse
An accounting block for VA, then the invoice continuation on the reverse with a 17A total, followed by the special provisions.
How VA Form 10-7078 is completed
- 1
VA issues the authorization
The issuing office fills in Items 1A to 12, including the services authorized, the period in Item 5 and the name and title of the person who authorized it.
- 2
The provider gives the authorized care
The special provisions say that, unless otherwise approved by VA, services are limited in type and extent to those shown on the authorization.
- 3
The provider completes the invoice
In Part II, enter the dates of service and either itemize the services or write As Authorized Above if they are identical to those authorized, then the fees, ID number, billing date and total.
- 4
Continue on the reverse if needed
Further invoice lines go on the back. The form says to enter the 17A total there and also enter it in Item 17 on the front.
- 5
Send reports to the authorizing facility
The provisions say a copy of the Operative Report goes to the authorizing facility within 1 week following any major surgery, and the hospital summary within 10 work days following the patient's release.
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Special provisions and edition
Payment in full
The form says payment by VA is payment in full for authorized services rendered, and fees or rates listed represent maximum allowance for the services specified.
Charges
The form says in no event should charges be made to the VA in excess of usual and customary charges to the general public for similar services.
Privacy Act
The form says accepting the authorization and providing the treatment subjects the provider of care to Public Law 93-579, the Privacy Act of 1974, to the extent of the records on the VA authorized treatment of this Veteran.
Questions and unused authorizations
Questions about the authorization go to the issuing VA Facility. If services are not initiated for any reason, the form says to return a copy of the authorization to the issuing office with a brief explanation.
Edition
The front footer reads VA FORM FEB 2005 (R) 10-7078, matching the February 2005 revision date on VA's page. The reverse footer reads JUN 2007.
Related forms
Who uses VA Form 10-7078?
The form splits the work between VA and the provider of care.
Official sources and the blank
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Questions about Form 10-7078
What is VA Form 10-7078 used for?
The form says its purpose is to authorize medical treatment and provide a means to bill for this service.
Who fills out VA Form 10-7078?
A VA issuing office completes the authorization in Part I. The individual or organization furnishing the service completes the invoice in Part II. Parts III and IV are for VA use only.
Can a provider bill on a different form?
The form says private providers may also use local billing forms or UB (Uniform Billing) Forms 92.
What does As Authorized Above mean on the invoice?
Item 14 says to enter the remark As Authorized Above if the services furnished are identical to those authorized. Otherwise, the services are itemized.
What if the authorized services never start?
The form says to return a copy of the authorization to the issuing office with a brief explanation.
Where do questions about the authorization go?
The form says all questions relating to this authorization should be referred to the issuing VA Facility.