PRACTICE REVIEW / SEPTEMBER 2026

Coverage review checklist.

A business-process checkpoint for your clinical, billing, and ordering teams. Not a coverage determination or a patient record.

0 of 7 review steps checked

Exact product and configurationMatch the product identity, item code, dimensions, and source labeling to the item under review.Payer and site of careIdentify the applicable payer, plan, contractor or jurisdiction, site of care, and planned date of service through your secure workflow.Current policy and effective dateReview the current coverage policy and related coding articles. Record the source, version, effective date, and unresolved questions in your internal record.Authorization or review pathwayConfirm whether prior authorization or another review process applies to the exact service and payer. Do not infer a requirement solely from a product category.Clinical documentation ownershipHave the responsible clinical and billing teams confirm that the records required by the applicable policy are complete. Keep patient information outside this website.Codes, units, and billing reviewConfirm current codes, units, and payer requirements. A product item code or geometric surface area is not a billing instruction.Commercial terms and unresolved riskConfirm product availability, account terms, and who owns any open payer or documentation question before an order is accepted.

Selections stay in this page only and reset on reload. Completing the checklist does not establish eligibility, authorization, coverage, or payment.

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WISeR IS NOT A BLANKET RULE

Check the exact service.

CMS WISeR applies to selected Original Medicare services in six states: Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. Participants can use prior authorization or a post-service, prepayment review pathway. Applicability depends on the service and current model guidance; the model does not itself change Medicare coverage or payment rules.

Reviewed September 6, 2026. Use the current CMS guide and applicable coverage documents for case-specific review.

CMS WISeR modelScope, locations, and current model updates WISeR provider and supplier guideCurrent service scope and review process Medicare Coverage DatabaseCurrent national and local policies and related articles