ACR Urges Review of CMS WISeR Guide Updates on ESI Doc Rules

ACR^® encourages members to review the latest CMS guidance in the updated WISeR Model Provider and Supplier Operational Guide.

The Center for Medicare and Medicaid Innovation released Version 6.0 of the WISeR (Wasteful and Inappropriate Service Reduction) guide. The update includes changes to documentation requirements for epidural steroid injections (ESI) for pain management. ACR members affected by WISeR should follow the manual to meet all documentation standards.

CMS applies prior authorization and pre-payment review to CPT code 62323 only when used for ESI. The code does not require prior authorization or pre-payment review under WISeR when used for other indications listed in local coverage determinations, including placement of an intrathecal pump for pain or spasticity.

ACR urges WISeR providers to read the updated guide and Appendix A WISeR select items and services. This will help ensure compliance and avoid claim issues. ACR launched a feedback survey to gather members’ experiences with WISeR and would appreciate member insights.

For more information or if you have questions, contact Alicia Blakey, ACR Manager Economic Policy.