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Original Medicare in six states now requires AI-assisted medical reviews for 13 specific procedures prone to overuse, including epidural steroid injections and certain implantable devices. Providers must seek prior authorization or face prepayment reviews, delaying payments. Reviewers are paid based on savings from denied claims, incentivizing cost reduction. The program aims to reduce unnecessary care and runs through 2031, with possible updates and no current nationwide expansion.

A new Medicare pilot program called WISeR, launched in six states, requires prior authorization or post-service review for 15 categories of outpatient procedures under Original Medicare. Providers can seek advance approval or proceed with post-payment review, but denied requests may shift costs to patients if an Advance Beneficiary Notice is signed. The program aims to reduce wasteful spending by reviewing care for coverage compliance before payment.