Medicare Prior Authorization WISeR Model Correction Notice

Regs.gov: Centers for Medicare and Medicaid Services

Published April 6th, 2026

Detected April 7th, 2026

Summary

CMS issued a correction notice to fix typographical and technical errors in the July 1, 2025 Federal Register notice about the WISeR (Wasteful and Inappropriate Services Reduction) Model for Medicare prior authorization. The corrections update specific lists of procedure codes for epidural steroid injections, vertebral compression fracture procedures, fusion procedures, and apnea treatments, while also clarifying applicability language for skin and tissue substitutes. The corrections are effective April 6, 2026, with applicability to January 1, 2026.

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What changed

This correction notice amends the July 1, 2025 WISeR Model notice by correcting typographical and technical errors in the lists of procedure codes subject to prior authorization. Specific corrections include: epidural steroid injections now list codes L39015, L39240, L36920 (excluding facet joint interventions); vertebral compression fracture now lists L38201, L34228, L35130; fusion procedures now list L39741, L39758, L39793; and apnea treatments now list L38307, L38310, L38385. The skin and tissue substitutes applicability language was clarified to specify selected MAC jurisdictions and states with active LCDs during WISeR performance years starting January 1, 2026.

Healthcare providers offering these specific services under Medicare should verify their services align with the corrected procedure code lists and update compliance systems accordingly. While this is an administrative correction rather than a substantive policy change, accurate code alignment remains important for proper prior authorization processing under the WISeR Model.

What to do next

Review the corrected WISeR items and services lists to ensure alignment with the updated procedure codes
Update any internal prior authorization workflows or systems with the corrected LCD procedure code lists
Monitor CMS communications for further WISeR Model updates

Source document (simplified)

Content

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:

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