Federal Register #CMS5056CN

Correction Notice: WISeR Model Prior Authorization Guidance Update

This notice provides a correction to previously published guidance from the Centers for Medicare & Medicaid Services (CMS) regarding the WISeR Model prior authorization process for select Medicare services. - Government Buyer: - Department of Health and Human Services (HHS) - Centers for Medicare & Medicaid Services (CMS) - No OEMs or vendors are mentioned in this notice - No products or services are being procured or awarded - Correction clarifies: - Typographical and technical errors in the original Federal Register notice - Service codes and coverage determinations (including National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs)) - Affected services include Epidural Steroid Injections for Pain Management, Vertebral Compression Fracture, Fusion, Apnea, and Skin and Tissue Substitutes - Purpose is to ensure accurate implementation of the WISeR Model, which targets reduction of fraud, waste, and abuse in Medicare fee-for-service - No procurement or contract opportunity is present in this notice

Description

This notice issued by the Centers for Medicare & Medicaid Services (CMS) corrects typographical and technical errors in a previously published Federal Register notice dated July 1, 2025. The original notice detailed the implementation of prior authorization procedures for select Medicare services under the Wasteful and Inappropriate Services Reduction (WISeR) Model, aimed at reducing fraud, waste, and abuse in Medicare fee-for-service. The correction clarifies specific service codes and coverage determinations applicable to the WISeR model, ensuring accurate guidance for implementation starting January 1, 2026.

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