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Wasteful and Inappropriate Service Reduction (WISeR) Model

  • Texas is one of six states participating in the Centers for Medicare & Medicaid Services’ WISeR prior authorization pilot, which runs from Jan. 1, 2026 to Dec. 31, 2031.

    Under this program, physicians must seek approval for the 14 identified services either from Cohere Health, the CMS-approved technology vendor, or undergo prepayment review before the claim is paid.

  • Trending WISeR News

  • Additional WISeR Resources

    • CMS webpage: Includes FAQs, a fact sheet, and a Provider and Supplier Operational Guide with a list of impacted codes

      Novitas informational webage: Includes program background, resources, and educational opportunities

      Cohere Health website: Includes background information on the CMS-approved WISeR technology vendor for Texas, as well as portal registration, training, and resources

    • Cohere Health FAQ
    • Federal regulation authorizing the WISeR pilot

  • Specialties

    Based on Cohere Health’s assessment of the codes subject to review, specialties and particular procedures within those specialties expected to be most impacted include:

  • 14 Services impacted by WISeR:

    The prior authorization process under this model will be implemented on the following items and services:

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  • Ask the TMA Knowledge Center

    Have WISeR questions? Call the Knowledge Center.

    (800) 880-7955