The Academy has been actively monitoring the Wasteful and Inappropriate Service Reduction (WISeR) Model since it was first implemented on January 1, 2026. The WISeR Model has expanded prior authorization, using enhanced technologies such as AI and machine learning tools, to Medicare fee-for-service patients for select items and services.
This model is currently live for the states of Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington, and is scheduled to run through December 31, 2031.
Services that are currently covered under the WISeR Model list include:
- Electrical nerve stimulators
- Sacral nerve stimulation for urinary incontinence
- Phrenetic nerve stimulators
- Vagus nerve stimulation
- Induced lesions of nerve tracts
- Epidural steroid injections for pain management excluding facet joint injections
- Percutaneous vertebral augmentation for vertebral compression fracture
- Cervical fusion
- Arthroscopic lavage and arthroscopic debridement for the osteoarthritic knee
- Hypoglossal nerve stimulation for obstructive sleep apnea
- Incontinence control devices
- Diagnosis and treatment of impotence
- Percutaneous image-guided lumbar decompression for spinal stenosis
- Skin and tissue substitutes
Background
The Centers for Medicare and Medicaid Services (CMS) and the Center for Medicare and Medicaid Innovation (CMMI) announced on June 27, 2025, that it would be implementing the Wasteful and Inappropriate Service Reduction (WISeR) Model at the very beginning of 2026. This announcement did not contain any formal opportunities for the public to provide input on this model and CMS provided less than seven months for preparation before implementation.
Per CMS, the WISeR Model aims “to expedite and improve the review process for a pre-selected set of services that are vulnerable to fraud, waste and abuse.” The program is for traditional Medicare only; Medicare Advantage is not covered by this model. Traditional Medicare has not usually involved a prior authorization process, so this model represents a significant expansion of utilization management for Medicare beneficiaries.
Additional resources are available on the CMS webpage. These resources include FAQs for providers, a fact sheet, and a Provider and Supplier Operational Guide with a full list of impacted codes.
Academy Actions
Your Academy has publicly expressed serious concerns with the WISeR Model since it was first proposed in June 2025 and has engaged with CMS and policymakers, along with other allied stakeholders and medical specialty societies, to push for either a halt to the implementation of this model, a delay on implementation, or significant changes to the model as initially proposed.
Your Academy sent a letter to CMS in September 2025 expressing serious concerns with the WISeR Model before its implementation. The Academy’s letter urged CMS to delay this proposal and work with physicians and other stakeholders to develop a better path forward for ensuring patient access to care and reducing burdens on physiatrists.
The Academy continues to work with other stakeholders to push back against the WISeR Model, including the Regulatory Relief Coalition (RRC) and the Coalition to Preserve Rehabilitation (CPR). Some of these efforts include:
The Academy has also joined several other specialty societies and the RRC in endorsing the Seniors Deserve SMARTER (Streamlined Medical Approvals for Timely, Efficient Recovery) Care Act of 2025 (H.R. 5940), bipartisan legislation that would, if implemented before the end of 2025, have kept the WISeR Model from going into effect. This common-sense legislation was introduced by Rep. Suzan DelBene (WA-01), the lead sponsor for the Improving Seniors’ Timely Access to Care Act of 2025, landmark prior authorization reform legislation that the Academy has also endorsed.
Your Academy will continue working with the Administration, congressional champions and coalition partners to oppose any additional expansions of prior authorization and to enact common-sense reforms to the prior authorization process where possible, including within the WISeR Model.
How You Can Help
Going forward, your voice and your experience as a PM&R physician will be vital to our continued advocacy success. If you have direct experience with the WISeR Model and wish to share information about how this model has negatively impacted your practice and your patients, please reach out to Academy staff at healthpolicy@aapmr.org. Your feedback will be incredibly impactful as the Academy continues to advocate for reducing physician burden and improving patient access to care.