WISeR Model Prior Authorization Technical Correction

Regs.gov: Centers for Medicare and Medicaid Services

Published April 6th, 2026

Detected April 6th, 2026

Summary

CMS issued a correction notice correcting typographical and technical errors in the July 1, 2025 Federal Register notice regarding the WISeR (Wasteful and Inappropriate Services Reduction) Model prior authorization requirements. The corrections refine the lists of Local Coverage Determination (LCD) codes for specific services including Epidural Steroid Injections, Vertebral Compression Fracture procedures, Fusion surgeries, and Sleep Apnea treatments. The corrections are effective April 6, 2026, with applicability to WISeR items and services implemented on January 1, 2026.

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What changed

CMS published a correction notice addressing typographical and technical errors in the WISeR Model prior authorization notice (90 FR 28749). The corrections narrow and clarify the lists of LCD codes for four service categories: Epidural Steroid Injections (reduced from 9 to 3 codes), Vertebral Compression Fracture (reduced from 8 to 3 codes), Fusion (reduced from 8 to 3 codes), and Apnea (reduced from 8 to 3 codes). Additional corrections clarify that Skin and Tissue Substitutes requirements apply only to selected WISeR MAC jurisdictions with active LCDs during performance years starting January 1, 2026.

Healthcare providers and MAC jurisdictions should review the corrected LCD code lists and update prior authorization submission procedures to reflect the accurate codes. The applicability date for these corrections is January 1, 2026, aligning with the original WISeR Model implementation date. No new compliance obligations are created; this is purely a technical correction to improve accuracy of the prior authorization requirements.

What to do next

Review the corrected LCD code lists for Epidural Steroid Injections, Vertebral Compression Fracture, Fusion, and Apnea services
Update prior authorization submission procedures to reflect the corrected LCD codes
Verify jurisdiction applicability for Skin and Tissue Substitutes requirements

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