Original Medicare Prior Authorizations Starting 2026

Are prior authorizations coming to Original Medicare? Starting in January 2026, a new pilot program will introduce prior authorizations for Original Medicare—but it’s not what you think. In this video, Medicare expert Matthew Claassen explains what the WISeR model is, why it’s being tested, and how it differs from the profit-driven prior authorization tactics used by Medicare Advantage plans.

This pilot program focuses on reducing fraud, waste, and abuse—not denying you necessary care. You'll learn exactly how Medicare prior authorizations are being used in this model, what kinds of outpatient services are affected, and which states are included in the rollout.

If you’re wondering whether Original Medicare prior authorizations will impact your coverage, this video is for you. Matthew answers common questions, clears up the confusion, and offers a transparent look at Medicare’s goals for the future.

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Here’s a clear rundown of the 17 services that will require prior authorization under the CMS Wasteful and Inappropriate Service Reduction (WISeR) Model, effective January 1, 2026 through December 31, 2031, in the six pilot states (AZ, OH, OK, NJ, TX, WA)

Electrical nerve stimulators

Sacral nerve stimulation for urinary incontinence

Phrenic nerve stimulators

Deep brain stimulation (for essential tremor or Parkinson’s)

Vagus nerve stimulation

Induced lesions of nerve tracts

Epidural steroid injections for pain management (excluding facet joint injections)

Percutaneous vertebral augmentation (for vertebral compression fractures)

Cervical spinal fusion

Arthroscopic lavage and debridement for osteoarthritic knee

Hypoglossal nerve stimulation (for obstructive sleep apnea)

Incontinence control devices

Diagnosis and treatment of impotence

Percutaneous image-guided lumbar decompression (for spinal stenosis)

Bioengineered skin substitutes for chronic non‑healing lower‑leg wounds

Cellular or tissue‑based products (CTPs) for lower extremity wound care

Skin and tissue substitutes (generally, under applicable MAC LCDs)

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