Ohio Included in New WISeR Medicare Prior Authorization Model for 17 Services
CMS recently announced the Wasteful and Inappropriate Service Reduction, or WISeR, model to test approaches to streamlining the prior authorization process by partnering with technology-focused companies. The model, which applies to traditional Medicare, will begin on Jan. 1, 2026, and run through Dec. 31, 2031.
While WISeR does not change Medicare coverage or payment policy, it will require providers in select states (Ohio, Arizona, New Jersey, Oklahoma, Texas and Washington) to either submit a prior authorization request to a WISeR model participant or Medicare Administrative Contractor, or MAC, or undergo a post-service/pre-payment medical review.
This model applies to 17 services including skin and tissue substitutes, electrical nerve stimulators and knee arthroscopies. A full list of affected items and services is available on page 6 of the federal notice.
