CMS is adding prior authorization requirements for certain fee-for-service procedures under traditional Medicare as part of its new Wasteful and Inappropriate Service Reduction model.
A total of 17 procedures, identified by CMS as especially vulnerable to fraud, waste or overuse, will be subject to this change. Among the affected services are epidural steroid injections for pain management, cervical spinal fusion, percutaneous image-guided lumbar decompression for spinal stenosis and percutaneous vertebral augmentation for vertebral compression fractures. Arthroscopy for knee osteoarthritis is also included in the list of targeted procedures.
To support the rollout of these authorizations, CMS is working with artificial intelligence and machine learning companies to test strategies for streamlining the prior authorization process.
The WISeR program is slated to begin on Jan. 1, 2026, and will continue through Dec. 31, 2031. Initially, the program will apply to providers in five states: Arizona, Washington, New Jersey, Texas and Oklahoma. CMS said the model does not alter existing Medicare coverage or payment policies, nor does it apply to Medicare Advantage plans.
Some spine surgeons are raising concerns about the program’s potential to disrupt patient care. Grant Booher, MD, a spine surgeon at Longhorn Brain & Spine in Fort Worth, Texas, said the move will create additional obstacles for both physicians and patients.
“CMS continues to make it harder for physicians to deliver timely, evidence-based care,” he told Becker’s. “Adding prior authorization requirements to procedures like cervical spinal fusion or epidural steroid injections — especially ones already governed by clinical judgment and imaging — only delays care, increases administrative burdens and worsens outcomes for patients in real pain.”
He added that while CMS positions the model as a value-based initiative, “it feels more like bureaucratic overreach. Spine surgeons aren’t ordering these procedures on a whim.”
Brian Gantwerker, MD, a spine surgeon at The Craniospinal Center of Los Angeles, voiced a similar critique, calling the program “fatally flawed.”
“While physicians are, of course, not above reproach for outcomes, it is still amazing to me that we think a person who never examined a patient or looked at their films or a machine for that matter can make a determination whether or not someone needs surgery,” he told Becker’s. “The hubris here is staggering”
Not all clinicians are opposed to the new oversight, however. Christian Zimmerman, MD, of St. Alphonsus Medical Group and SAHS Neuroscience Institute in Boise, Idaho, said that some of the targeted procedures merit more stringent review.
“Prior authorizations are overdue for many of these mechanically inadequate (relieving), and near placebo rendering procedures promulgated by many non-surgeons/pain administrators,” he told Becker’s. “The presentations of objective data sets coupled with demonstrable radiologic adjunct should be equally scrutinous as the pursuance of complex spinal surgery. The approval process should parallel one’s own correlative data, outcomes and complications, clinical experience and appropriate correlates of disease and surgical application. Too many patients present to the surgical forum after having three and four series of epidural injections with the same dissatisfying, repetitive result.”
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