Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model; Correction
AI-generated summary for informational purposes only. Not legal advice. See the original source for the authoritative text.
This notice corrects typographical and technical errors in a July 1, 2025 Federal Register notice regarding the Medicare WISeR Model. The corrections refine the list of medical services subject to prior authorization and pre-payment review starting January 1, 2026. Specific changes narrow the LCD codes associated with epidural steroid injections, vertebral compression fracture treatments, spinal fusions, sleep apnea services, and skin/tissue substitutes. The updates also clarify applicability to only certain MAC jurisdictions and states with active LCDs during the WISeR performance years.
AI-generated summary. May contain errors. Refer to official sources for legal decisions.
Key Changes
- Effective date of corrections: April 6, 2026
- Applicability date for corrected WISeR list and LCDs: January 1, 2026
- Epidural Steroid Injections corrected to only LCDs L39015, L39240, L36920 (excluding facet joint injections)
+ 4 more changes with Pro
Obligations
What this law requires
Implement prior authorization and pre-payment review for Epidural Steroid Injections for Pain Management using only LCD codes L39015, L39240, and L36920, excluding Facet Joint Interventions, effective January 1, 2026
Implement prior authorization and pre-payment review for Vertebral Compression Fracture (VCF) treatment using only LCD codes L38201, L34228, and L35130, effective January 1, 2026
Implement prior authorization and pre-payment review for Fusion procedures using only LCD codes L39741, L39758, and L39793, effective January 1, 2026
Implement prior authorization and pre-payment review for Sleep Apnea services using only LCD codes L38307, L38310, and L38385, effective January 1, 2026
Apply prior authorization and pre-payment review for Skin and Tissue Substitutes only to selected WISeR MAC jurisdictions and states that have an active LCD in place during WISeR performance years starting January 1, 2026