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The Centers for Medicare and Medicaid Services (CMS) has announced a new innovation center model aimed at helping ensure people with original Medicare receive safe, effective and necessary care.  

Through the Wasteful and Inappropriate Service Reduction (WISeR) Model, CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process relative to original Medicare’s existing processes, helping patients and providers avoid unnecessary or inappropriate care and safeguarding federal taxpayer dollars. This model builds on other changes being made to prior authorization as announced by the U.S. Department of Health and Human Services and CMS on Monday.

The impacted services for IR are percutaneous vertebral augmentation for vertebral compression fracture and epidural steroid injections for pain management (excluding facet joint injections). This model will be tested in JH and JL (Novitas), JF (Noridian), and J15 ( Celerian Group Company CGS). The selected states are New Jersey (JL), Ohio (J15), Oklahoma and Texas (JH), and Arizona and Washington (JF). The model will commence on Jan. 1, 2026, and will conclude on Dec. 31, 2031.

The WISeR Model will test a new process on whether enhanced technologies, including artificial intelligence (AI), can expedite the prior authorization processes for select items and services that have been identified as particularly vulnerable to fraud, waste and abuse, or inappropriate use. These items and services include, but are not limited to, skin and tissue substitutes, electrical nerve stimulator implants, and knee arthroscopy for knee osteoarthritis. The model excludes inpatient-only services, emergency services and services that would pose a substantial risk to patients if significantly delayed.

The WISeR Model will not change Medicare coverage or payment criteria. Health care coverage for original Medicare beneficiaries remains the same, and beneficiaries retain the freedom to seek care from their provider or supplier of choice. Under the model, providers and suppliers in the assigned regions will have the choice of submitting prior authorization requests for selected items and services, or their claim will be subject to pre-payment medical review. Those providers and suppliers that choose to submit a prior authorization may either submit their request directly to model participants or to their Medicare Administrative Contractor that will forward the request to the model participant. CMS may include a pathway in the future that would allow providers and suppliers with strong compliance records to qualify for exemptions from WISeR review, which would further reduce administrative burden and allow greater focus on high-risk areas. The WISeR Model does not impact people enrolled in Medicare Advantage. Read more information about the WISeR Model and view the Federal Register notice. 

View the model overview fact sheet.