An Overview of the CMS Innovation Center’s WISeR Model

• November 12, 2025

• Neal Shah, JD, MPH , Polsinelli

In June 2025, the Center for Medicare & Medicaid Innovation (CMMI) announced a payment model applying prior authorization functions to the fee-for-service Medicare program. The model (the Wasteful and Inappropriate Service Reduction Model (WISeR Model)) will engage certain entities (Model Participants) to implement new prior authorization or medical review processes (Utilization Management) for certain Medicare fee-for-service claims in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. Utilization Management will apply to all Medicare Part B claims for the affected services filed in these states. CMMI outlined the structure of the program and requirements for Model Participants in its Request for Applications (RFA), supplemented with a Frequently Asked Questions document and a Provider and Supplier Operational Guide. The model will be in effect for six years (through 2031).

ARTICLE TAGS

• Regulation, Accreditation, and Payment Practice Group
• Government Reimbursement