The Centers for Medicare & Medicaid Services has delayed implementation of prior authorization requirements for select procedures under the WISeR model, citing the need for additional operational readiness.

The pause applies to procedures including image-guided lumbar decompression and deep brain stimulation, both previously identified as targets for utilization oversight.

The WISeR model, launched in 2025 across six states, is designed to reduce fraud and overuse by introducing prior authorization and AI-supported coverage determinations.

Industry groups, including the Society of Interventional Radiology, have raised concerns about unclear standards, administrative burden, and potential delays in patient care tied to the model.

Physician coalitions representing over 100,000 clinicians also flagged risks associated with integrating automated decision tools into an already complex utilization management environment.

CMS indicated the delay will allow time to address operational challenges, with a future notice expected to outline next steps and revised timelines.

The broader WISeR initiative remains active and continues to focus on services identified as high risk for misuse, signaling that prior authorization expansion in traditional Medicare is still moving forward.

Source:  Radiology Business