Medicare’s Wasteful and Inappropriate Service Reduction (WISeR) Model

On June 27, 2025, the Centers for Medicare & Medicaid Innovation Center (CMMI) announced the Wasteful and Inappropriate Service Reduction (WISeR) payment model, a new prior authorization process for specific procedures that began on January 15, 2026. Under this model, Medicare is using Artificial Intelligence companies in coordination with human clinical review to assess certain procedures and claim submissions. Physicians and practices are expected to submit a prior authorization request for the selected services or go through a post-service/pre-payment review for designated procedures, including skin and tissue substitutes, electrical nerve stimulators, and knee arthroscopy for knee osteoarthritis.  

Technology companies participating in the model are expected to reduce inappropriate utilization and Medicare spending using Artificial Intelligence (AI). This model differs from previous models most notably due to its omission of the formal public notice-and-comment rulemaking process. 

The new prior authorization requirement is mandatory in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington within Medicare Administrative Contractor (“MAC”) jurisdictions J15, JH, and JF. Medicare-enrolled physicians and practices in these jurisdictions may opt-in to submit prior authorization requests for selected services (see table below) or have their submitted claims reviewed post-procedure and prior to payment.