Article
What the model does
CMS launched the Wasteful and Inappropriate Service Reduction model on January 1 as a six-year test in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington. It applies prior authorization or prepayment review to a list of services in traditional Medicare that CMS considers prone to overuse, including several nerve stimulator implants, epidural steroid injections, cervical fusion, knee arthroscopy for osteoarthritis and certain skin substitutes. Inpatient-only and emergency services are excluded, and Medicare Advantage is not affected.
Private technology companies review requests in each Medicare contractor region, with clinicians making any non-payment recommendation. The companies are paid a share of the spending they help avert, adjusted for the accuracy and timeliness of their decisions. Providers that skip prior authorization face prepayment medical review instead. CMS has said it is exploring a gold-card exemption for providers with high approval rates.
The pushback
Sen. Maria Cantwell of Washington released a report saying hospitals in her state are seeing waits two to four times longer in some cases, with patients waiting weeks for approvals that were not needed before. She has called for the program to end, and other Democratic lawmakers have also urged CMS to stop it. CMS has framed the model as a tool against fraud and unnecessary spending.
CMS has already adjusted course once. In an April 6 notice, it postponed review of deep brain stimulation and image-guided lumbar decompression to allow more time for operational readiness, with no new start date.
What to measure now
- Turnaround time: Track days from order to decision for each WISeR service, compared with the same period last year.
- Outcomes: Log approvals, non-affirmations, resubmissions and peer-to-peer requests.
- Patient impact: Note cancellations, rescheduled cases and patients who switch to other settings or forgo care.
- Cost: Estimate added staff hours and any revenue delayed by prepayment review.
- Gold-card readiness: Strong documentation now could position high-performing physicians for exemption later.
Hospitals outside the six states should still watch closely, since CMS may add services or regions in future years.
Archive entry for Apr 22, 2026, added Nov. 11, 2026.
Sources
- Federal test of prior authorization is delaying care in Washington, senator says (STAT, Apr 22, 2026)
- Delayed implementation of certain WISeR prior authorization services (Federal Register, Apr 6, 2026)
- Implementation of prior authorization for select services for the WISeR model (Federal Register, Jul 1, 2025)