The Center for Medicare & Medicaid Innovation (CMMI) on June 27 announced a new model to test prior authorization in Medicare fee-for-service.
The Wasteful and Inappropriate Service Reduction (WISeR) model will run from January 1, 2026, through December 31, 2031. The voluntary model partners with technology companies to explore whether tools like artificial intelligence can streamline and improve the prior authorization process.
Participants will oversee specific geographic regions across six states (Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington), and providers in those areas can choose to submit prior authorization requests for selected items and services or undergo post-service, pre-payment medical review. Licensed clinicians must make all final determinations.
The 17 initial targeted services include those particularly vulnerable to fraud, waste and inappropriate use, according to the Centers for Medicare & Medicaid Services (CMS). They include deep brain stimulation for Parkinson’s Disease, epidural steroid injections for pain management, cervical fusion, skin and tissue substitutes, and arthroscopy for knee osteoarthritis.
The model excludes emergency services, inpatient-only procedures, and services that could endanger patients if delayed. WISeR will not change Medicare coverage or payment rules and applies only to traditional Medicare, not Medicare Advantage.
For more information, CMS published a fact sheet and FAQ for the model.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
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