Overview

• The CMS WISeR pilot will launch on Jan. 1, 2026 in Washington, New Jersey, Ohio, Texas, Arizona, and Oklahoma, run for six performance years, and apply to people in Original Medicare.
• Private contractors will use enhanced technologies, including artificial intelligence, to review requests, with any denial decided by an appropriately licensed human clinician rather than a machine.
• Emergency services, inpatient-only care, and services that could substantially endanger patients if delayed are excluded from the new review requirements.
• The model targets roughly a dozen services flagged as vulnerable to waste or abuse, including skin and tissue substitutes, electrical nerve stimulators, knee arthroscopy for osteoarthritis, cervical fusion, certain steroid injections, incontinence devices, and some impotence treatments.
• Contractors will be paid in part based on reductions in unnecessary or non-covered services, a design CMS defends as anti-waste as Democratic lawmakers, physicians, and experts warn of delays, added burdens, and a possible shift from traditional Medicare to Medicare Advantage.