Medicare Pilot Requires Prior Authorization for 13 Services in Six States

CBS News reported that Oklahoma cattle farmer Bill Curry, 65, made two round trips totaling 10 hours of driving in early 2026 after learning during a February visit to Oklahoma City that preapproval was now required for his quarterly epidural injection.

The Wasteful and Inappropriate Service Reduction Model, or WISeR, began in mid-January 2026 in six states after its announcement in June 2025. The pilot applies prior authorization to 13 services, including spinal epidurals and kyphoplasty, in traditional Medicare.

CBS News reported that the University of Washington medical system had nearly 100 patients waiting for epidural injections earlier in 2026 because of WISeR-related delays. New Jersey physician Dorota Gribbin said one patient required more expensive hospital care after authorization arrived late.

Oklahoma radiologist James Webb said kyphoplasty reimbursements now take six to eight weeks instead of the standard 15 days.

Phoenix-area doctor Jerry Sobel said as of May 2026 he had not been paid for nine epidurals performed under the program. Humata Health CEO Jeremy Friese, whose company serves Oklahoma, said the AI system issues an immediate yes in 88 percent of cases with supporting clinical data. CMS stated decisions are returned within 72 hours and clinicians receive a universal tracking number.

Contractors acknowledged the pace. Friese said the rollout was aggressive from notification to launch. Zyter executive Sundar Subramanian said the company monitors operations and works with stakeholders.

An April 2026 Zyter webinar noted a backlog in payments dating to January that is being resolved. A KFF poll from January 2026 found 69 percent of insured adults view prior authorization as a burden. The Department of Health and Human Services inspector general reported in September 2025 that Medicare spending on skin substitutes, one of the 13 services, rose nearly 700 percent in two years.