| Outpatient Department demo | ASC Prior Authorization Demonstration | WISeR | |
|---|---|---|---|
| Where | Hospital outpatient departments only (POS 19, 22) | Ambulatory surgery centers | ASCs, hospital outpatient departments, offices, home |
| Where geographically | — | Ten states, including Texas | Six states: AZ, NJ, OH, OK, TX, WA |
| What it covers | A defined list of hospital outpatient services | Five cosmetic categories: blepharoplasty, botulinum toxin, panniculectomy, rhinoplasty, vein ablation | 13 categories — spine, pain, neurostimulators |
| Running since | 2020 | TX, AZ and OH began February 16, 2026 | January 2026, through December 2031 |
| Relevant to an ortho, spine or pain ASC? | No | Rarely | Yes — this is the one |
1. The Outpatient Department demonstration
Site of service: hospital outpatient departments only. Running since 2020.
This is the oldest of the three and the one most often assumed to apply more broadly than it does. It reaches services performed in a hospital outpatient department — places of service 19 and 22 — and it does not reach ambulatory surgery centers at all.
If your cases are performed in an ASC, this program is not yours, regardless of what a payer representative or a colleague at a hospital-affiliated center may have described.
2. The ASC Prior Authorization Demonstration
Site of service: ambulatory surgery centers. Ten states, including Texas. Texas, Arizona and Ohio began February 16, 2026.
This one is ASC-specific, which is why its name causes so much confusion — an administrator hears “the ASC prior authorization demonstration” and reasonably assumes it covers their surgical volume.
It does not. The demonstration covers five cosmetic and cosmetic-adjacent categories: blepharoplasty, botulinum toxin injection, panniculectomy, rhinoplasty, and vein ablation.
For a center with meaningful dermatology, plastics, vein or oculoplastic volume, this program is operationally significant. For an orthopedic, spine or pain center, it will touch very little of the schedule — while a different program touches a great deal of it.
3. WISeR
Sites of service: ambulatory surgery centers, hospital outpatient departments, physician offices and the home. Six states. Model period January 1, 2026 through December 31, 2031.
WISeR is the one that reaches the surgical volume most centers actually care about: cervical fusion, epidural steroid injections, radiofrequency ablation and the nerve-tract lesion family, spinal cord and sacral nerve stimulators, vertebral augmentation, and hypoglossal nerve stimulation for sleep apnea, among the 13 active categories.
It is also the first time fee-for-service Medicare has applied prior authorization at this scale, which is why it is the program with the steepest operational learning curve.
Two programs at once is the normal case
An orthopedic and pain center in Texas is inside WISeR and inside the ASC Prior Authorization Demonstration simultaneously, for entirely different procedures — spine and pain cases under the first, any vein or cosmetic volume under the second. Neither program supersedes the other and neither is a subset of the other.
A hospital-affiliated outpatient department in one of the six WISeR states can likewise be under both WISeR and the Outpatient Department demonstration.
The practical instruction is the same in every case: identify the program by the procedure, not by the name of the program.
And none of these is CMS-0057
One more distinction, because it is the most common of all. The three programs above apply to traditional fee-for-service Medicare. CMS-0057 is a different thing entirely — a final rule placing obligations on Medicare Advantage plans, Medicaid and CHIP programs, and Qualified Health Plan issuers on the federal exchanges. Its prior authorization decision timelines took effect January 1, 2026, and its API requirements arrive January 1, 2027.
A center can be under WISeR for its fee-for-service Medicare cases and see CMS-0057's effects on its Medicare Advantage cases in the same week. They are unrelated regimes that happen to share a vocabulary.
Do you know which of your cases sit under which program?
Most centers answer that by procedure, from memory, one case at a time — which is also why the rolled-up numbers each program is judged on never get totalled. We will show you what the assembled view looks like, in thirty minutes.
This content is for informational purposes only and does not constitute legal or regulatory advice. Consult your compliance counsel for authoritative guidance on your specific obligations.