By Jed Morrison

Effective January 1, 2026, the Centers for Medicare & Medicaid Services (CMS) has adopted a test program to reduce inappropriate utilization of certain selected Medicare procedures. The program, the Wasteful and Inappropriate Services Reduction (WISeR) Model, will be implemented for six years in six states, including Texas and Oklahoma. WISeR only applies to traditional fee for service Medicare, but the result of the pilot program will likely be significant, with additional denials of coverage for the listed procedures in those states.

CMS and its Medicare Administrative Contractors (MAC’s) in those jurisdictions will contract with artificial intelligence (AI) companies to electronically process prior authorization requests for the selected procedures. Not surprisingly, the AI companies are compensated by Medicare through shared savings of reduced utilization of services.

The identified procedures are those that CMS characterizes as “low value,” and historically susceptible to fraud, waste and abuse.  They are as follows:

• Electrical Nerve Stimulators (NCD 160.7)
• Sacral Nerve Stimulation for Urinary Incontinence (NCD 230.18)
• Phrenic Nerve Stimulator (NCD 160.19)
• Deep Brain Stimulation for Essential Tremor and Parkinson’s Disease (NCD 160.24)
• Vagus Nerve Stimulation (NCD 160.18)
• Induced Lesions of Nerve Tracts (NCD 160.1)
• Epidural Steroid Injections for Pain Management excluding facet joint injections (L39015, L33906, L39036, L39240, L39242, L36920, L38994, L39054)
• Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fracture (VCF) (L33569, L34106, L34228, L38201, L34976, L35130, L38737, L38213)
• Cervical Fusion (L39741, L39799, L39770, L39758, L39762, L39793, L39773, L39788)
• Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee (NCD 150.9)
• Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (L38276, L38307, L38398, L38387, L38310, L38312, L38385, L38528)
• Incontinence Control Devices (NCD 230.10)
• Diagnosis and Treatment of Impotence (NCD 230.4)
• Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis (NCD 150.13)
• Skin and Tissue Substitutes (Local Coverage Determinations (LCDs) below)—only applicable to MAC jurisdictions and states that have an active LCD in place
  • Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041)
  • Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities (L36690)

There is nothing that providers can do, other than to monitor denials of care for these procedures.  Providers who perform many of these procedures should reacquaint themselves with the national coverage determinations (NCD) and local coverage determinations (L or LCD) referenced in the above list to identify possible compliance weaknesses.

Most Medicare Advantage plans already use advanced AI technology for these same purposes, and arguably this just brings traditional Medicare in line with managed care Medicare. Nonetheless, patients and providers can expect additional denials of coverage for these procedures. If you have any questions, please contact Jed Morrison at jmorrison@jw.com.

The opinions expressed are those of the author and do not necessarily reflect the views of the firm, its clients, or any of its or their respective affiliates. This article is for informational purposes only and does not constitute legal advice. For assistance, please contact an attorney in Jackson Walker’s Healthcare & Life Sciences practice.