Article
Medicare WISeR model requires prior authorizations in six states
Jan. 13, 2026 · Authored by Kyrsten Shipp, Georgia Green
Beginning Jan. 1, 2026, Medicare providers and suppliers in six states will need to obtain payment authorization for a variety of items and services under the Wasteful and Inappropriate Service Reduction (WISeR) Model.
The WISeR Model tests the use of advanced technology, such as Artificial intelligence (AI), to reduce the provision of medically unnecessary care for certain services susceptible to fraud, waste, and abuse (FWA).
It’s designed to provide Medicare beneficiaries with safe and appropriate care, safeguard taxpayer funds, ease the provider administrative burden, and expedite payment decisions.
The model will be in effect for six performance years, through Dec. 31, 2031, and operate in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington.
WISeR will apply to services provided on or after Jan. 15, 2026, allowing ample lead time to process requests and schedule approved services.
What’s the WISeR model methodology?
WISeR targets a specific group of services that have historically been associated with higher risks of FWA, or may be of low value to Medicare beneficiaries. Examples include skin and tissue substitutes, electrical nerve stimulators, and epidural steroid injections for pain management.
This model, split into two three-year agreements, will be a collaboration between the Centers for Medicare and Medicaid Services (CMS) and technology companies (the model participants) to enhance and accelerate the prior authorization process for the selected services.
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