Texas Adds WISeR Prior Authorization

In Texas, traditional Medicare patients seeking selected outpatient procedures now face a coverage review either before treatment or before payment under a new federal test.
Active categories in Texas included epidural steroid injections, cervical fusion, nerve stimulators, vertebral augmentation, certain knee procedures, incontinence devices, erectile-dysfunction treatments, and wound-care substitutes.
Texas providers could seek advance approval, with reviewers generally responding within 3 business days or 2 for expedited cases, or accept prepayment review afterward.
If coverage was not affirmed in Texas, providers could resubmit with more documentation and request clinician discussion; patients should read any noncoverage notice carefully.
Federal officials left room to add more services in Texas, so patients and providers benefited from confirming billing codes, review routes, records, and costs early.