WISeR Model Prior Authorization Requirements Correction
Summary
CMS issued a correction notice to fix typographical and technical errors in the WISeR Model prior authorization requirements originally published July 1, 2025. The corrections revise the list of covered service codes for epidural steroid injections, vertebral compression fracture procedures, fusion procedures, and sleep apnea services, reducing the number of applicable codes in each category. The notice also clarifies that Skin and Tissue Substitutes prior authorization applies only to selected WISeR MAC jurisdictions with active LCDs during performance years starting January 1, 2026.
What changed
This correction notice revises the list of healthcare service codes subject to prior authorization under the WISeR (Wasteful and Inappropriate Services Reduction) Model. CMS reduced the applicable codes for four service categories: Epidural Steroid Injections changed from 8 codes to 3 codes (L39015, L39240, L36920); Vertebral Compression Fracture reduced from 8 codes to 3 codes (L38201, L34228, L35130); Fusion procedures reduced from 8 codes to 3 codes (L39741, L39758, L39793); and Sleep Apnea services reduced from 8 codes to 3 codes (L38307, L38310, L38385). The notice also clarifies that Skin and Tissue Substitutes prior authorization applies only to selected WISeR MAC jurisdictions and states with active LCDs.
Healthcare providers and Medicare Administrative Contractors (MACs) should review the corrected code lists and ensure their prior authorization processes align with the revised requirements, which are applicable retroactively to January 1, 2026. The corrected information is available on the CMS WISeR model webpage. Providers should contact Kate Blackwell at (844) 711-2664, Option 8, or WISeR@cms.hhs.gov for additional information.
What to do next
- Review the corrected WISeR service code lists and update prior authorization workflows accordingly
- Verify that Skin and Tissue Substitutes coverage aligns with the clarified MAC jurisdiction requirements
- Ensure compliance systems reflect the reduced code sets retroactive to January 1, 2026
Source document (simplified)
Notice
Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model; Correction
A Notice by the Centers for Medicare & Medicaid Services on 04/06/2026
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- Public Inspection Published Document: 2026-06617 (91 FR 17282) Document Headings ###### Department of Health and Human Services
Centers for Medicare & Medicaid Services
- [CMS-5056-CN]
AGENCY:
Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS).
ACTION:
Notice; correction.
SUMMARY:
This document corrects typographical and technical errors in the notice that appeared in the July 1, 2025, Federal Register titled “Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model”.
DATES:
The corrections in this notice are effective April 6, 2026.
Applicability date: The corrections in section II.1.a. of this notice are applicable to the list of WISeR items and services and their affiliated local coverage determinations (LCDs) for which prior authorization and pre-payment review processes were implemented on January 1, 2026.
FOR FURTHER INFORMATION CONTACT:
Kate Blackwell (844) 711-2664, Option 8 or WISeR@cms.hhs.gov.
SUPPLEMENTARY INFORMATION: ( printed page 17283)
I. Background and Summary of Errors
In FR Doc. 2020-12195 of July 1, 2025 (90 FR 28749), there were typographical and technical errors. This document corrects those errors.
II. Correction of Errors
In FR Doc. 2025-122195 of July 1, 2025 (90 FR 28749), make the following corrections:
- On page 28751,
a. Second column,
(1) Third bulleted paragraph, lines 1 through 5, the paragraph “• Epidural Steroid Injections for Pain Management excluding facet joint injections (L39015, L33906, L39036, L39240, L39242, L36920, L38994, L39054)” is corrected to read “• Epidural Steroid Injections for Pain Management (L39015, L39240, L36920) excluding Facet Joint Interventions”.
(2) Fourth bulleted paragraph, lines 2 through 5, the phrase “Vertebral Compression Fracture (VCF) (L33569, L34106, L34228, L38201, L34976, L35130, L38737, L38213)” is corrected to read “Vertebral Compression Fracture (VCF) (L38201, L34228, L35130)”.
(3) Fifth bulleted paragraph, lines 1 through 3, the phrase “Fusion (L39741, L39799, L39770, L39758, L39762, L39793, L39773, L39788)” is corrected to read “Fusion (L39741, L39758, L39793)”.
(4) Seventh bulleted paragraph, lines 2 through 4, the phrase “Apnea (L38276, L38307, L38398, L38387, L38310, L38312, L38385, L38528)” is corrected to read “Apnea (L38307, L38310, L38385)”.
(5) Eleventh bulleted paragraph, lines 1 through 4, the paragraph “• Skin and Tissue Substitutes (LCDs below)—only applicable to MAC jurisdictions and states that have an active LCD in place” is corrected to read “• Skin and Tissue Substitutes (LCDs below): Only applicable to selected WISeR MAC jurisdictions and states with an active LCD in place during the WISeR performance years starting on January 1, 2026.”
b. Third column, first full paragraph, lines 23 and 24, the phrase “Additional information about the WISeR model is available” is corrected to read “Additional information about the WISeR model and the most current WISeR items and services and their affiliated NCDs and LCDs are available”.
The Administrator of the Centers for Medicare & Medicaid Services (CMS), Dr. Mehmet Oz, having reviewed and approved this document, authorizes Chyana Woodyard, who is the Federal Register Liaison, to electronically sign this document for purposes of publication in the Federal Register.
Chyana Woodyard,
Federal Register Liaison, Centers for Medicare & Medicaid Services.
[FR Doc. 2026-06617 Filed 4-3-26; 8:45 am]
BILLING CODE 4120-01-P
Published Document: 2026-06617 (91 FR 17282)
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