{"id":1310,"date":"2025-09-30T17:32:54","date_gmt":"2025-09-30T23:32:54","guid":{"rendered":"https:\/\/www.wenatcheeinsurance.com\/blog\/?p=1310"},"modified":"2025-09-30T17:41:56","modified_gmt":"2025-09-30T23:41:56","slug":"washington-state-and-the-new-prior-authorizations-for-medicare","status":"publish","type":"post","link":"https:\/\/www.wenatcheeinsurance.com\/blog\/washington-state-and-the-new-prior-authorizations-for-medicare\/","title":{"rendered":"Washington State and the new Prior Authorizations for Medicare"},"content":{"rendered":"\n
\"Prior<\/figure>\n\n\n\n

Beginning January 1st, 2026 some medical procedures under traditional Medicare will require Prior Authorization in six states before performing the service. Yes, Washington state has been selected. Arizona, New Jersey, Ohio, Oklahoma, and Texas. <\/p>\n\n\n\n

This updates individuals with Medigap<\/strong> plans such as Plan G or Plan N, if they are using traditional Medicare coverages. While common in health plans and Medicare Advantage Plans these are new for original Medicare. <\/p>\n\n\n\n

This change is part of a trial program called WISeR (Wasteful and Inappropriate Services Reduction)<\/a>. It is designed to curb medical overuse and detect potential fraud. <\/p>\n\n\n\n

What Procedures will require a Prior Authorization?<\/h2>\n\n\n\n

There were 17 types of procedures that were flagged to now need approval. Here is what made the list. <\/p>\n\n\n\n