Becker's Healthcare October 29, 2025
The Wasteful and Inappropriate Service Reduction initiative from CMS is set to take effect Jan. 1, 2026, introducing new prior authorization requirements for select services.
Here are seven things to know:
1. The WISeR model will launch as a pilot program in Arizona, Washington, New Jersey, Texas, Ohio and Oklahoma through Dec. 31, 2031. Providers in these states, including ASCs, will be required to follow the new prior authorization protocols.
2. CMS contractors will use a combination of artificial intelligence tools and clinical review to evaluate prior authorization requests, according to CMS. The process will align with existing Medicare coverage policies and patient safety standards.
3. The initial procedures subject to prior authorization include:
- Electrical nerve stimulator implants
- Epidural...
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