On June 23, 2026, KFF Health News reporter Darius Tahir described what the first months of a new Original Medicare review looked like in six states. Bill Curry, 65, raises cattle in rural Oklahoma and had been driving two and a half hours to Oklahoma City each quarter for an epidural in his spine. This year the clinic told him, on a trip already underway, that the shot now needed preapproval. He went back later for the injection. The clinic then wanted a third visit, which he said was "just to fill out a piece of paper to tell them how you feel again." He has not gone.
James Webb, a musculoskeletal radiologist in Tulsa, told KFF: "Six- to eight-week delays is what we've been seeing." Those waits were not a change in what Medicare covers. They were a new paperwork step that produces a number.
What CMS built
The Centers for Medicare & Medicaid Services calls the demonstration the Wasteful and Inappropriate Service Reduction Model, or WISeR. The model page, last updated August 4, 2026, says it runs from January 1, 2026, through December 31, 2031, in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington. The participants are technology companies: Cohere Health in Texas, Genzeon in New Jersey, Humata Health in Oklahoma, Innovaccer in Ohio, Virtix Health in Washington, and Zyter in Arizona.
The official notice is Federal Register document 2025-12195 (90 FR 28749), published July 1, 2025, and effective January 1, 2026. CMS began accepting requests on January 5, 2026, for services on or after January 15, 2026. The model does not apply to Medicare Advantage, Railroad Medicare, inpatient-only care, emergencies, or services that would pose a substantial risk if delayed.
CMS says WISeR does not change coverage rules or payment rates for covered items. What it changes is when a review happens, and who does the first pass. The agency's FAQ says the aim is auto-approvals where possible, with most responses inside 72 hours.
The list is a narrow set of items CMS ties to fraud, waste, abuse, and inappropriate use. Agency examples include skin and tissue substitutes, implantation of electrical nerve stimulators, and knee arthroscopy for osteoarthritis. KFF's June reporting also treats epidurals and kyphoplasty as among the services clinics now send through this step. Skin substitutes are in the model only in states with an active local coverage determination.
Three doors, one number
A clinic in a WISeR state that plans to bill Original Medicare for a listed service has three practical doors, not two.
It can send a prior authorization request to the technology company for that state. If the request is provisionally affirmed, the company and the Medicare contractor generate a Unique Tracking Number. That number goes on the claim.
It can send the same request to the Medicare Administrative Contractor. The contractor forwards it to the technology company. CMS's FAQ states: "The 72-hour turnaround time applies to the WISeR participant." Extra time can be added for the contractor to pass the file along and pass the decision back.
Or the clinic can skip prior authorization, deliver the service, and bill. In that case the claim is held for pre-payment medical review. Skipping the number is not the same as skipping the review.
CMS's FAQ states: "A human clinician with relevant clinical expertise for selected items and services must review every non-affirmation." Technology alone cannot issue that result. A non-affirmation is also not a final claims denial. The clinic can resubmit without a cap, or furnish the service and bill; a later denial can be appealed. Before furnishing a non-affirmed service, the physician is supposed to give the patient an Advanced Beneficiary Notice of Non-Coverage.
The companies are paid a percentage of expenditures tied to care the reviews avert. CMS says they can be penalized for inaccurate determinations, including recoupment if a non-affirmation is later overturned on appeal. That is agency policy, not a record of how any one file was handled.
What clinics and patients said in June
Humata's chief executive, Jeremy Friese, told KFF there is an "immediate yes" in 88 percent of cases for which clinical data supports an approval. That is one vendor, in Oklahoma, talking about the subset of files that already look payable. It is not a CMS-wide rate.
Abe Sutton, director of the Center for Medicare and Medicaid Innovation, said in a statement to KFF: "The model aims to reduce inappropriate care without delaying appropriate care." He also said the percentage of providers committing waste, fraud, and abuse is small.
The University of Washington medical system had nearly 100 patients waiting earlier in 2026 for epidural injections because of WISeR-related delays, according to an April report from Sen. Maria Cantwell's office that drew on hospital association data.
On June 24, 2026, Healthcare Dive reported that 31 House Democrats wrote to CMS Administrator Mehmet Oz asking for the average time from a vendor determination to the moment a physician actually receives the tracking number. The advertised one-to-three-day window, the letter argued, may measure only the company's decision. CMS said it would review the letter. That reply is not in the public record used here.
Some doctors told KFF they believe denials sometimes garbled clinical facts. Friese said he has not heard of that. Those accounts are not a measured error rate.
Why skin substitutes are on the list
On September 3, 2025, the HHS Office of Inspector General issued report OEI-BL-24-00420. It found that Medicare Part B spending on skin substitutes had surpassed $10 billion annually by the end of 2024. CMS's FAQ says the WISeR list was derived in part from Inspector General reports. The $10 billion figure is a reason the category was targeted. It is not a savings number for WISeR.
What the evidence cannot establish
The June 2026 reporting shows extra trips and waits longer than the vendor clock in named clinics. It does not show how often that happens across six states, whether waits have shortened since early summer, or that an automated first pass caused any specific wrong denial. It does not prove that the model has reduced waste.
A House committee vote to block funds, reported in June, is not enacted law. A claim that one vendor was ordered into a corrective action plan is disputed by that vendor and is not treated as fact here.
This is not medical, coverage, or legal advice. No article can tell you whether a particular procedure will be paid.
Before you drive
If you have Original Medicare and live in New Jersey, Ohio, Oklahoma, Texas, Arizona, or Washington, and a clinic is planning a listed outpatient procedure, ask three things in writing or at the desk before you leave home. Does this service need a Unique Tracking Number. Who has it. On what date was it issued.
Keep that date with the appointment. If the clinic does not have a number yet, you at least know whether the extra trip is for care or for a file that has not come back.
If you are not in those states, the same question still works: does this visit need a tracking number. The answer should be short.