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WISeR model — official scope and submission references

For included services, choose prior authorization or undergo pre-payment medical review; neither pathway guarantees payment. CMS specifies a 72-hour turnaround for requests sent to a WISeR participant electronic portal from January 5, 2026, for service dates on or after January 15, 2026. This clock applies to the participant; requests through a MAC may take additional forwarding and response-routing time. It is not a guaranteed end-to-end deadline for every submission route. The reviewed program scope is Original Medicare in New Jersey, Ohio, Oklahoma, Texas, Arizona and Washington, based on service location. Requests concern selected services with dates of service on or after January 15, 2026; a state match alone does not establish that a particular service or claim is included. Railroad Medicare, UPIC review and services already under other CMS prior-authorization programs have separate exclusions in the guide. This directory does not supply the withheld CPT/indication mapping or determine medical necessity. Use the official participant or MAC instructions to confirm the route, service, setting and any applicable exclusion before preparing a request. An administrative submission route or a provisional affirmation is not a guarantee of payment. No patient information is collected by this reference page. Source checked 2026-10-15. Documentary verification only; no clinical review or individual coverage determination.

Prior authorization: unknown. Member-specific applicability must be checked with the payer.
PayerCMS / Medicare
Plan contextOriginal Medicare — reference context only
ServiceWISeR model
State scopeNot verified
Effective dateNot verified
RevisionSource 5b66ca78dd36
Retrieved10/15/2026
EvidenceOpen original source ↗

Source evidence

Documentary checks establish what the official source says, not clinical eligibility.

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SUBSCRIBER WORKSPACE

Turn source research into a repeatable workflow.

This public reference is available in full above. Paid research tools are not currently available; no clinical checklist or cross-payer authorization determination is included.

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Evidence fingerprint: 5b66ca78dd36029df489baa51d633659a7050ff38e403dec19bd1db63e27b284