Medicare 2026 Pilot: Which Procedures Will Require Prior Authorization?

Starting in January 2026, Medicare will launch a pilot program requiring prior authorization for a wide range of medical procedures, marking the first time traditional Medicare beneficiaries, not just those in Medicare Advantage, will face these requirements.

The initiative will begin in six states,  Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington, and aims to curb fraud, unnecessary treatments, and excess spending.

What makes this pilot especially controversial is its reliance on artificial intelligence (AI) and private contractors to review requests before a licensed clinician makes the final decision.

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Medical Procedures Affected in 2026

According to an update from CMS, the following procedures will require prior authorization under the new Medicare pilot:

• Electrical Nerve Stimulators

• Sacral Nerve Stimulation for Urinary Incontinence

• Phrenic Nerve Stimulator

• Deep Brain Stimulation for Parkinson’s Disease and Essential Tremor

• Vagus Nerve Stimulation

• Induced Lesions of Nerve Tracts

• Epidural Steroid Injections for Pain Management (excluding facet joint injections)

• Percutaneous Vertebral Augmentation (PVA) for Vertebral Compression Fractures

• Cervical Fusion

• Arthroscopic Lavage and Debridement for Osteoarthritic Knees

• Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

• Incontinence Control Devices

• Diagnosis and Treatment of Impotence

• Percutaneous Image-Guided Lumbar Decompression for Spinal Stenosis

• Skin and Tissue Substitutes (in states with active Local Coverage Determinations)

The Medicare prior authorization pilot represents one of the biggest shifts in traditional Medicare in decades.

With AI playing a central role in medical decision-making, the program could reduce waste and costs, but also risks slowing down access to critical care for older adults.
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