Medicare AI Prior Authorization Experiment Faces Delays and Criticism

Centers for Medicare & Medicaid Services Deputy Administrator Kimberly Brandt acknowledged that Medicare's experiment using AI-assisted prior authorization is falling short. The Wasteful and Inappropriate Service Reduction model, known as WISeR, began on January 1, 2026, and is scheduled to run through 2031. WISeR requires advance approval or review before payment for specific outpatient services that CMS considers low-value or vulnerable to fraud, waste, and abuse.

The program affects 6.4 million Original Medicare beneficiaries across six states. The delays in approval are noted as a major issue for older adults and their caregivers, potentially impacting necessary procedures. Covered services include electrical nerve stimulators, epidural steroid injections, and certain knee procedures.