Medicare Program: Delayed Implementation of Certain Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction Model

Medicare Program; Delayed Implementation of Certain Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model

DATES:

The notice is effective April 6, 2026.

SUPPLEMENTARY INFORMATION:

I. Background

In the July 1, 2025, Federal Register (90 FR 28749), we published a notice titled "Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model". The notice announced a 6-year model focused on reducing fraud, waste (including low-value care), and abuse in Medicare fee-for-service (FFS) via the implementation of technology-enabled prior authorization processes for select services. For more detailed information regarding the WISeR Model, see the July 2025 notice (90 FR 28749).

II. Delayed Implementation of Select Services

In the July 2025 notice (90 FR 28751), we specified that the prior authorization process under the model will be implemented in the selected states for the listed items and services with affiliated national coverage decisions (NCDs) or local coverage decisions (LCDs) beginning January 1, 2026. We are delaying implementation of two of the services announced in the July 2025 notice to allow additional time for operational readiness. Implementation of the prior authorization or pre-payment review process for these two services is delayed until a future date that will be announced in a subsequent Federal Register notice. Until the future implementation date is announced, neither the prior authorization nor the pre-payment review processes described in our earlier notice will be available for these services. The two services for which we are delaying implementation of the prior authorization or pre-payment review process are as follows:

• Deep Brain Stimulation for Essential Tremor and Parkinson's Disease (NCD 160.24).
• Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis (NCD 150.13).

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 .