Medicare Program; Delayed Implementation of Certain Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model
AI-generated summary for informational purposes only. Not legal advice. See the original source for the authoritative text.
The Centers for Medicare & Medicaid Services (CMS) has issued a notice delaying the start of prior authorization and pre-payment review requirements for two specific services under the new WISeR Model. Originally scheduled to begin on January 1, 2026 in selected states, the implementation for these two procedures is now postponed to a future date to be announced later. The WISeR Model aims to reduce fraud, waste, and low-value care in Medicare fee-for-service through technology-enabled prior authorization processes linked to existing National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs). Until the new date is published in a subsequent Federal Register notice, neither prior authorization nor pre-payment review will apply to these two services.
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Key Changes
- Implementation of prior authorization for Deep Brain Stimulation for Essential Tremor and Parkinson's Disease (NCD 160.24) delayed from January 1, 2026 to a future date
- Implementation of prior authorization for Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis (NCD 150.13) delayed from January 1, 2026 to a future date
- No prior authorization or pre-payment review processes will apply to these two services until a subsequent Federal Register notice announces the new implementation date
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Obligations
What this law requires
Do not implement prior authorization requirements for Deep Brain Stimulation for Essential Tremor and Parkinson's Disease (NCD 160.24) until a future date is announced in a subsequent Federal Register notice
Do not implement pre-payment review requirements for Deep Brain Stimulation for Essential Tremor and Parkinson's Disease (NCD 160.24) until a future date is announced in a subsequent Federal Register notice
Do not implement prior authorization requirements for Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis (NCD 150.13) until a future date is announced in a subsequent Federal Register notice
Do not implement pre-payment review requirements for Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis (NCD 150.13) until a future date is announced in a subsequent Federal Register notice
Publish a subsequent Federal Register notice announcing the future implementation date for prior authorization and pre-payment review for the two delayed services