CMS to add prior authorization for spine procedures in traditional Medicare

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Some fee-for-service spine procedures in traditional Medicare will have prior authorizations added, according to CMS’ new Wasteful and Inappropriate Service Reduction model.

CMS is partnering with AI and machine learning companies to test ways to implement an expedited prior authorization process for some Medicare services including spine and orthopedic services.

Seventeen services will be targeted, including ones CMS says are vulnerable to fraud, waste and inappropriate use. They include epidural steroid injections for pain management, cervical spinal fusion, percutaneous image-guided lumbar decompression for spinal stenosis and percutaneous vertebral augmentation for vertebral compression fracture. Arthroscopy for knee osteoarthritis will also be affected .

WISeR will run from Jan. 1, 2026, through Dec, 31, 2031, and the model will begin with providers in Arizona, Washington, New Jersey, Texas and Oklahoma. It doesn’t alter Medicare coverage or payment rules, and doesn’t affect Medicare Advantage plans.

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