Advocacy is one of the three pillars of ASRA Pain Medicine's mission. ASRA Pain Medicine addresses this core purpose by advocating at the regulatory level in the best interest of our members and the patients they serve. (Note: ASRA Pain Medicine does not participate in political advocacy.)
The Latest Health Policy Updates
CMS Provides More Details on WISeR Prior Authorization Model
Confirms January 2026 Launch Despite Government Shutdown
The Centers for Medicare & Medicaid Innovation (CMMI) has confirmed that the Wasteful and Inappropriate Service Reduction (WISeR) model will launch January 1, 2026, as planned, despite recent federal budget uncertainty and staff changes. The update came during an October 22 webinar hosted by the American Medical Association (AMA) and CMMI, where agency leaders outlined details and responded to clinicians’ questions.
WISeR aims to curb waste, fraud, and abuse in the fee-for-service (Original) Medicare program by introducing prior authorization requirements for select outpatient services. Contractors will use artificial intelligence (AI) and clinical review to assess requests, following existing Medicare coverage policies and patient safety standards. The model will be tested in six states across four Medicare Administrative Contractor (MAC) jurisdictions: New Jersey (JL), Ohio (J15), Oklahoma and Texas (JH), and Arizona and Washington (JF).
Initial services subject to prior authorization include electrical nerve stimulator implants, epidural steroid injections for pain management excluding facet joint injections, percutaneous vertebral augmentation for vertebral compression fracture, and percutaneous image-guided lumbar decompression for spinal stenosis.
CMMI Deputy Administrator Abe Sutton noted that WISeR participation will technically be voluntary, but providers in affected regions will face an added step in claims processing by having to either submit prior authorization requests before treatment or undergo post-service/pre-payment review.
Sutton said this program differs from Medicare Advantage prior authorization programs in how contractors are incentivized. He emphasized that contractors will not be incentivized to deny claims, but to “get the determination right.” Coverage decisions are expected within 72 hours (48 for expedited cases). Payment and coverage policies will not change, and clinicians will retain their existing administrative appeal rights.
Looking ahead, CMMI also intends to pilot a “gold carding” feature by mid-2026. The feature would exempt clinicians with consistent approval histories from future prior authorization or pre-payment review.
Although CMMI has not detailed how AI will be deployed, officials said it will serve primarily as a process tool to streamline approvals. When coverage is denied, a human clinician with relevant expertise will need to get involved. The agency will evaluate WISeR’s outcomes before considering geographic or procedural expansion. If successful, WISeR could serve as a blueprint for broader prior authorization reforms across Medicare, as well as potentially the private sector.
For more information, see these resources:
Read More
CMS Provides More Details on WISeR Prior Authorization Model
Confirms January 2026 Launch Despite Government Shutdown
The Centers for Medicare & Medicaid Innovation (CMMI) has confirmed that the Wasteful and Inappropriate Service Reduction (WISeR) model will launch January 1, 2026, as planned, despite recent federal budget uncertainty and staff changes. The update came during an October 22 webinar hosted by the American Medical Association (AMA) and CMMI, where agency leaders outlined details and responded to clinicians’ questions.
WISeR aims to curb waste, fraud, and abuse in the fee-for-service (Original) Medicare program by introducing prior authorization requirements for select outpatient services. Contractors will use artificial intelligence (AI) and clinical review to assess requests, following existing Medicare coverage policies and patient safety standards. The model will be tested in six states across four Medicare Administrative Contractor (MAC) jurisdictions: New Jersey (JL), Ohio (J15), Oklahoma and Texas (JH), and Arizona and Washington (JF).
Initial services subject to prior authorization include electrical nerve stimulator implants, epidural steroid injections for pain management excluding facet joint injections, percutaneous vertebral augmentation for vertebral compression fracture, and percutaneous image-guided lumbar decompression for spinal stenosis.
CMMI Deputy Administrator Abe Sutton noted that WISeR participation will technically be voluntary, but providers in affected regions will face an added step in claims processing by having to either submit prior authorization requests before treatment or undergo post-service/pre-payment review.
Sutton said this program differs from Medicare Advantage prior authorization programs in how contractors are incentivized. He emphasized that contractors will not be incentivized to deny claims, but to “get the determination right.” Coverage decisions are expected within 72 hours (48 for expedited cases). Payment and coverage policies will not change, and clinicians will retain their existing administrative appeal rights.
Looking ahead, CMMI also intends to pilot a “gold carding” feature by mid-2026. The feature would exempt clinicians with consistent approval histories from future prior authorization or pre-payment review.
Although CMMI has not detailed how AI will be deployed, officials said it will serve primarily as a process tool to streamline approvals. When coverage is denied, a human clinician with relevant expertise will need to get involved. The agency will evaluate WISeR’s outcomes before considering geographic or procedural expansion. If successful, WISeR could serve as a blueprint for broader prior authorization reforms across Medicare, as well as potentially the private sector.
For more information, see these resources:
Pain Medicine Coalition
ASRA Pain Medicine and the American Society of Anesthesiologists (ASA) established the Pain Medicine Coalition (PMC) in 2024 to advance the common goals of the pain medicine community and to advocate for responsible pain care for all patients. The International Pain & Spine Intervention Society (IPSIS) and the American Academy of Physical Medicine and Rehabilitation (AAPM&R) are also members of the coalition. Its purpose is to develop, monitor, and advocate for responsible health care policy for people who experience both acute and chronic pain and the physicians who support them. They do their work through clinical care, education addressing quality of care, access to care, public and professional education, and research.
Read more about the Pain Medicine Coalition:
ASA and ASRA Pain Medicine: Speaking With One Voice
President’s Message: The Power of ASRA Pain Medicine Volunteers
Are You a Member of AMA?
The American Medical Association (AMA) is the nation's largest physician organization and works to advocate for key issues that matter in your practice such as prior authorization, Medicare reform, promoting physician-led work, and more. ASRA Pain Medicine works with the AMA to advocate for the issues that matter in your practice with representation in the AMA House of Delegates, the Relative Value Scale Update Committee, and the Current Procedural Terminology Committees. ASRA Pain Medicine provides expert information and testimony specific to regional anesthesia and acute and chronic pain.
Learn more about the benefits of membership in AMA.
Read the latest AMA news and sign up for news alerts at ama-assn.org.
Practice Management
Find more health policy information in our Practice Management Resource Center.