08/31/2025
News you can use! Starting January 1, 2026, Texas is one of 6 states participating in a Medicare program called WISeR - Wasteful and Inappropriate Services Reduction. The purpose is to curb medical overuse and prevent fraud. This program will impact people who have a Medicare Supplement/Medigap policy. I'm not going to take a stand on it until I understand it a bit better and see how it plays out, today, I'm the messenger. Below is a list of the procedures and an article. Please leave a comment, let me know what you think.
Facet joint procedures for back pain
Nerve and muscle tests (electrodiagnostic testing)
TENS units and similar electrical stimulation devices
Hyperbaric oxygen therapy
Spinal cord stimulators
Deep brain stimulation (commonly for Parkinson’s)
Sacral neuromodulation (for urinary conditions)
Transcatheter aortic valve replacement (TAVR)
Arthroscopic knee cleaning or debridement
Vertebroplasty/kyphoplasty for spine fractures
Epidural steroid injections
Non-emergency ambulance transport
https://www.resourcemedicare.com/post/new-medicare-changes-in-2026-prior-approval-required-for-these-17-services
Botox injections for medical issues
Negative pressure wound therapy pumps
Hernia repairs
Lumbar spinal fusion
Skin graft substitutes for chronic wounds
Starting Jan 1, 2026, Medicare will require prior authorization for 17 procedures in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. The WISeR program aims to cut waste, reduce fraud, and improve patient safety, but could also cause delays and more paperwork.