Medicare tightens patient access rules by 2026 in these six states: “We’ll help save taxpayer money”
Preauthorization will be available to Original Medicare applicants in six states. Here's everything you need to know.
The Centers for Medicare & Medicaid Services (CMS) have announced upcoming changes for applicants to Traditional Medicare, also known as Original Medicare, in six U.S. states. Beginning January 1, 2026, CMS will implement a preauthorization requirement for certain medical services under a new initiative called the Wasteful and Inappropriate Service Reduction (WISeR) Model.
According to CMS, the WISeR Model is designed to help patients and providers avoid unnecessary or inappropriate care while also protecting federal taxpayer dollars. The agency will test whether advanced technologies, including artificial intelligence (AI), can help streamline the preauthorization process for services identified as especially vulnerable to fraud, waste, abuse, or misuse.
States Participating in the WISeR Model
The WISeR Model will be rolled out in the following six states:
- New Jersey
- Ohio
- Oklahoma
- Texas
- Arizona
- Washington.
CMS will partner with technology companies that specialize in advanced review systems. These companies will operate in designated geographic regions and assist in evaluating and processing preauthorization requests.
Services Subject to Preauthorization
The services that will require preauthorization under the WISeR Model include, but are not limited to:
- Electrical nerve stimulators
- Sacral nerve stimulation for urinary incontinence
- Phrenic nerve stimulators
- Deep brain stimulation for essential tremor and Parkinson’s disease
- Vagus nerve stimulation
- Induced nerve tract lesions
- Epidural steroid injections for pain management (excluding facet joint injections)
- Percutaneous vertebral augmentation (PVA) for vertebral compression fractures
- Cervical spinal fusion
- Arthroscopic lavage and debridement for osteoarthritic knees
- Hypoglossal nerve stimulation for obstructive sleep apnea
- Incontinence control devices
- Diagnosis and treatment of erectile dysfunction
- Image-guided percutaneous lumbar decompression for spinal stenosis
- Skin and tissue substitutes.
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