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ACG
h.o.l.M.E.S.
Automated Clinical Guidelines
ΨΥΧΗΣ ΙΑΤΡΕΙΟΝ
Cognitive WISeR Model
Indicates Non-covered Service
Beginning January 1, 2026, the prior authorization process under this model will be implemented in the selected states on the following items and services with affiliated NCDs or LCDs. WISeR is a pilot program that will be implemented in six states (New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington) for a period of six years, starting January 1, 2026, and ending December 31, 2031.
Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds (L39764)
Prior Authorization: ASC Services
On December 15, 2025, CMS will start a 5-year prior authorization demonstration for certain services provided in ASCs in Ohio (Arizona, California, Florida, Georgia, Maryland, New York, Pennsylvania, Tennessee, and Texas).
Beginning on December 1, 2025, providers can submit prior authorization requests for dates of service on or after December 15, 2025.
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