What the WISeR model is, who it affects, and why the payment structure matters. As of January 1, 2026, prior authorization exists in Original Medicare for the first time.
WISeR — Wasteful and Inappropriate Service Reduction — is a six-year pilot program run by the Center for Medicare and Medicaid Innovation (CMMI). It launched January 1, 2026, and runs through December 31, 2031. It applies to Original Medicare only, not Medicare Advantage.
Under WISeR, private technology companies contracted by CMS use artificial intelligence to review prior authorization requests for a specific list of 17 services before Medicare will pay for them. A licensed clinician must review every denial, but the AI does the initial screening.
If you do not live in one of these six states, WISeR does not currently affect you.
CMS designed WISeR so that participating technology companies are paid based on how much Medicare spending they reduce. Payments to contractors are calculated as a percentage of the savings directly attributed to their denial and review activity.
A bipartisan amendment to prohibit WISeR from being funded passed the House Appropriations Committee in September 2025. It was not included in the final spending bill. The program launched as planned.
| Included Services (partial list) | Timelines |
|---|---|
| Skin and tissue substitutes (wound care products) | Standard: 72 hours Expedited: 48 hours |
| Spinal decompression for spinal stenosis | |
| Cervical fusion procedures | |
| Knee arthroscopy for osteoarthritis | |
| Bone cement injections and nerve destruction procedures |
WISeR is explicitly designed as a test. If the model shows savings, CMS has the authority to expand it to more states and more services. Before WISeR, there were approximately 0.01 prior authorization reviews per traditional Medicare beneficiary per year. Medicare Advantage beneficiaries faced 1.8 reviews per person. WISeR is the first step toward closing that gap — in the wrong direction.
