The Centers for Medicare & Medicaid Services (CMS) has announced a new pilot program called the Wasteful and Inappropriate Service Reduction (WISeR) model. This initiative will introduce prior authorization requirements for certain services covered under traditional Medicare. The CMS WISeR Medicare prior authorization model aims to cut unnecessary procedures and costs. It also aims to improve the prior authorization process by using artificial intelligence and clinician oversight.
The program will begin in January 2026 and continue through December 2031. It will first launch in Arizona, Washington, New Jersey, Texas, and Oklahoma. CMS has identified 17 Medicare services most likely to be overused or misused. These include deep brain stimulation for Parkinson’s disease, epidural steroid injections for pain, cervical fusion, skin and tissue substitutes, and knee arthroscopy.
Unlike automated systems, the WISeR model keeps the final decision-making in the hands of clinicians. CMS will partner with vendors who are paid based on how much wasteful spending they prevent. However, the model will not change Medicare coverage rules or affect emergency care.
In addition, WISeR supports a larger CMS and HHS effort to modernize the healthcare system. According to CMS, low-value services continue to drive up costs. In fact, Medicare spent an estimated $5.8 billion on such services in 2022 alone. These services may increase costs for patients and contribute little to their overall health outcomes.
As a result, healthcare professionals should stay informed about WISeR’s rollout and its impact on documentation, approvals, and patient care.
Read the source article on Becker’s Hospital Review.
Source Attribution:
This article is a summary based on reporting by Alan Condon, Becker’s Hospital Review, June 30, 2025. It has been republished and adapted with permission. You can read the original article [here].
