Apr. 17, 2026
Latest Updates on WISeR Prior Authorization Pilot Program
Responding to concerns raised by our members and guided by our extensive policies around prior authorization, the WSMA continues to raise concerns with the Wasteful and Inappropriate Service Reduction Initiative pilot program that launched earlier this year and applies prior authorization requirements for the first time ever to traditional Medicare plans. Read on for the latest on this priority issue for patients and the physician community.
Virtix Health announces WISeR Gold Card Exemption Program
Virtix Health, in coordination with the Centers for Medicare and Medicaid Services, has announced the upcoming launch of the WISeR Gold Card Exemption Program, set to debut July 6. The program will recognize eligible physicians and suppliers in Washington state who consistently meet Medicare coverage criteria by granting exemptions from prior authorization and prepayment review requirements for WISeR services.
Physicians achieving gold card status may benefit from streamlined administrative processes and reduced review requirements. A Gold Card Exemption Program Fact Sheet is now available through the Virtix Health WISeR Resource Center, and additional program details are available at Virtix Health's website.
CMS delays implementation of two WISeR Model services
CMS has announced a delay in implementing two services under the WISeR Model pilot, according to a notice published in the Federal Register: deep brain stimulation for essential tremor and Parkinson's disease, and percutaneous image-guided lumbar decompression for spinal stenosis. CMS indicated that a new implementation date for these services will be announced in a future Federal Register notice.
WSMA advocacy
The WSMA continues to raise concerns with federal policymakers regarding the WISeR Model, citing its impact on patient access to care and practice operations. Physicians have reported increased administrative burden and delays in care delivery associated with prior authorization requirements. The WSMA remains actively engaged with CMS and congressional stakeholders to advocate for refinements that reduce unnecessary barriers and support timely patient care.
At WSMA's urging, several members of Washington state's congressional delegation signed onto a letter urging appropriators to block funding for the model.
Are you subject to WISeR? Share your experience
We strongly encourage impacted practices to share their experiences with WISeR with us—including administrative challenges, access issues, and impacts on patient care (positive or negative). The WSMA is uniquely positioned to serve as a conduit between Washington physicians, members of Congress, Virtix, Noridian, CMS, and the media. Your experience under WISeR is critical to informing ongoing congressional oversight and future CMS decision-making. Please contact WSMA Director of Policy Jeb Shepard at jeb@wsma.org to share your feedback.