Preauthorization for traditional Medicare
The Trump Administration is introducing Preauthorization for traditional Medicare, even though it is the item most consumers find as most burdensome in our healthcare system.
Here are the items selected for review this year. I could find no justification for this selection other than “The WISeR Model tests the use of enhanced technology to decrease certain wasteful (low-value) services shown to have little to no clinical, evidence-based benefit. Technology companies participating in the model help streamline the review of medical necessity for select items and services earlier in the claims process to: 1) reduce inappropriate utilization, 2) lower spending in Original Medicare, 3) expedite decision making and(4) ease provider administrative burden.”
Who has shown these items to have no clinical, evidence-based benefit? RFK Jr?
1. Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee (NCD 150.9)
2. Induced Lesions of Nerve Tracts (NCD 160.1)
3. Vagus Nerve Stimulation (NCD 160.18)
4. Phrenic Nerve Stimulators (NCD 160.19)
5. Electrical Nerve Stimulators (NCD 160.7)
6. Incontinence Control Devices (NCD 230.10)
7. Sacral Nerve Stimulators for Urinary Incontinence (NCD 230.18)
8. Diagnosis and Treatment of Impotence (NCD 230.4)
9. Percutaneous Vertebral Augmentation for Vertebral Compression Fracture (L34228, L38201, L35130)
10. Epidural Steroid Injections for Pain Management (L39015, L39240, L36920)
11. Cervical Fusion (L39741, L39758, L39793)
12. Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea (L38307, L38310, L38385)
13. Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L35041) and Wound Application of Cellular and/or Tissue Based Products (CTPs), Lower Extremities (L36690)
14. Deep Brain Stimulation (NCD 160.24) – implementation delayed and will not occur on January 1, 2026; to be re-evaluated for implementation in a future performance year
15. Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis (NCD 150.13) – implementation delayed and will not occur on January 1, 2026; to be re-evaluated for implementation in a future performance year.