Medicare Program; Implementation of Prior Authorization for Select Services for the Wasteful and Inappropriate Services Reduction (WISeR) Model

Document Headings Document headings vary by document type but may contain the following: the agency or agencies that issued and signed a document the number of the CFR title and the number of each part the document amends, proposes to amend, or is directly related to the agency docket number / agency internal file number the RIN which identifies each regulatory action listed in the Unified Agenda of Federal Regulatory and Deregulatory Actions See the Document Drafting Handbook for more details. Department of Health and Human Services Centers for Medicare & Medicaid Services [CMS-5056-N] AGENCY: Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (HHS). ACTION: Notice. SUMMARY: This notice announces a 6-year model focused on reducing fraud, waste (including low-value care), and abuse in Medicare fee-for-service (FFS) via the implementation of technology-enabled prior authorization processes for select services. DATES: This notice is effective on January 1, 2026. FOR FURTHER INFORMATION CONTACT: Kate Blackwell (844) 711-2664, Option 8 or WISeR@cms.hhs.gov . SUPPLEMENTARY INFORMATION: I. Background Wasteful medical care spending, broadly defined as spending that could be reduced or eliminated without adversely affecting quality of care or health outcomes, accounts for an estimated 25 percent of total health care spending in the United States (U.S.). [ 1 2 ] Medicare accounts for nearly one quarter of U.S. health care spending ($1 trillion in 2023) making it an important target for identifying and reducing waste. [ 3 ] The Medicare program is particularly vulnerable to wasteful spending due to the age and complexity of the Medicare population and their disproportionately high share of health care spending compared to younger segments of the U.S. population. [ 4 ] Additionally, the Medicare fee-for-service (FFS) payment structure may further drive waste given there is an inherent incentive in some cases for fraudulent ac…