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December 22, 2025

We are pleased to welcome you to the CMS/CMMI Wasteful and Inappropriate Service Reduction (WISeR) Model. This prior authorization program is launching in Washington state on January 1, 2026, for select procedures performed on/after January 15, 2026. Procedures included in this model include:

  • Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis (NCD 150.13);
  • Arthroscopic Lavage and Arthroscopic Debridement for the Osteoarthritic Knee (NCD 150.9);
  • Induced Lesions of Nerve Tracts (NCD 160.1);
  • Vagus Nerve Stimulation (NCD 160.18);
  • Phrenic Nerve Stimulator (NCD 160.19);
  • Electrical Nerve Stimulators (NCD 160.7);
  • Incontinence Control Devices (NCD 230.10);
  • Sacral Nerve Stimulation for Urinary Incontinence (NCD 230.18);
  • Diagnosis and Treatment of Impotence (NCD 230.4);
  • Percutaneous Vertebral Augmentation for Vertebral Compression Fracture (LCD L34106);
  • Epidural Steroid Injections for Pain Management (LCD L39240);
  • Cervical Fusion (LCD L39758);
  • Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea (LCD L38310);
  • Application of Bioengineered Skin Substitutes to Lower Extremity Chronic Non-Healing Wounds and Wound Application of CTPs, Lower Extremities (LCD 39764)

Providers and suppliers have two WISeR Model pathways:

1. Prior Authorization:

  • Submit a prior authorization request to receive a determination prior to administering WISeR select items and services.
  • May be submitted via electronic portal, mail or fax. A determination will be issued within 3 days of receiving the request.

2. Pre-Payment Medical Review:

  • Furnish WISeR select items and services immediately and wait for the determination through pre-payment review.
  • An ADR (additional documentation request) will be sent to the Provider, which will have 45-days to return before the medical review may commence. A determination will be issued within 3 days of receiving all necessary documentation.

 

In order to submit and track prior authorization requests electronically you will need to register for the Virtix Health WISeR Provider Portal.

  • You will receive an email from donotreply.wisersupport@virtixhealth.com in the next 48 hours
  • This email will have your USERID/Temporary Password/URL and instructions.
  • The password code will be valid for 7 days.
  • If you do not receive the email or are unable to complete registration within 7 days of receipt, please reach out to wiser.support@virtixhealth.com for assistance.
  • Please download the Microsoft Authenticator App on your iPhone/Android device. This is needed to complete onboarding.

To save time, electronic submission will allow you to track the status of your request and receive a quicker response. However, if you prefer, prior authorization requests can also be submitted via fax at 972-823-9415 or mailed to:

 

Virtix Health

6509 Windcrest Dr Ste 165

Plano TX 75024

 

When submitting a request please provide a request document https://virtixhealth.com/wiser/wiser-intake-form-download/ and complete medical record documentation to support the request.

If you have questions or need assistance please do not hesitate to contact us via email at wiser.support@virtixhealth.com or call us Monday thru Friday between the hours of 8am-6pm PST at 833-943-2209.

We look forward to working with you.

 

Sincerely,

Virtix Health

VirtixHealth.com
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