New Jersey Chosen for Medicare’s WISeR Program in 2026
- Ken Connolly
- Jul 8
- 2 min read
Updated: Sep 16
The program will add prior authorization requirements to 17 procedures for enrollees of Original Medicare in New Jersey starting January 1st, 2026.
Call NJ Life and Health at 848-226-6897 or visit our website at www.njlifeandhealth.com
WISeR Explained
In an effort to curb waste, fraud, and abuse in Original Medicare, The Center for Medicare and Medicaid Services (CMS) has created the “Wasteful and Inappropriate Service Reduction” model, otherwise known as WISeR. The program plans to use AI technology in tandem with physicians to help flag potential abuses by providers and hospitals who overbill Medicare.
The program will be limited to 17 procedures in 6 states initially and will run from January 1st 2026 to Dec 31st, 2031. New Jersey has been chosen as one of the 6 states.
WISeR Procedures:
The first procedures chosen for WISer are -
Electrical nerve stimulators
Sacral nerve stimulation for urinary incontinence
Phrenic nerve stimulator
Deep brain stimulation for essential tremor and Parkinson’s disease
Vagus nerve stimulation
Induced lesions of nerve tracts
Epidural steroid injections for pain management
excluding facet joint injections
Percutaneous vertebral augmentation (PVA) for vertebral compression fracture
Cervical fusion
Arthroscopic lavage and arthroscopic debridement for the 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
Skin and Tissue Substitutes
Application of bioengineered skin substitutes to lower extremity chronic non-healing wounds
Wound Application of cellular and/or tissue based products (CTPs), lower extremities
What this Means for NJ Medicare Enrollees:
New Jersey Original Medicare enrollees will largely see no changes to their healthcare. If you currently do not need any of these procedures, you will likely not notice any difference.
If you need any of the 17 listed procedures, your provider may submit a prior authorization before the procedure is done or may look for a post–service review.
Original Medicare vs Medicare Advantage for Prior Authorizations
Even with the implementation of WISeR, it is likely Original Medicare will still have far fewer cases of prior authorizations going forward.
In 2023, Original Medicare conducted just under 400,000 prior authorization reviews. In contrast, Medicare Advantage insurers made nearly 50 million prior authorization determinations in the same year.
Work With Our Medicare Brokers Right Here In NJ!
If you want to work with Medicare brokers who stay on top of all news to make sure you are protected, work with NJ Life and Health! Our team is here year round to make sure you have the best possible Medicare plan for your needs.
Call our Toms River, NJ office at 848-226-6897 or schedule your 1-on-1 call today.
Citations:
Levalley, D. (2025, July 7). Prior Authorization Coming to Traditional Medicare Starting in 2026. Kiplinger. https://www.kiplinger.com/retirement/medicare/prior-authorization-coming-to-traditional-medicare
Bienek, J., Sroczynski, N., Freed, M., & Neuman, T. (2025, January 28). Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023. Kaiser Family Foundation. https://www.kff.org/medicare/issue-brief/nearly-50-million-prior-authorization-requests-were-sent-to-medicare-advantage-insurers-in-2023/