A category is not a code match
A broad label may contain services with different treatment. Confirm the exact official entry.
Service scope
CMS WISeR selected services
Use the current official list and code-level instructions. Category labels and old spreadsheets are not enough.
CMS and official participant instructions control the selected-service list. WISeRly is independent, not CMS-affiliated or endorsed, not an official participant, does not issue determinations, and does not guarantee authorization or payment.
A reliable code verification workflow
- Identify the actual ordered service and anticipated billing code without upcoding or guessing.
- Open the current CMS/participant service material for the relevant state and date.
- Match the exact code and any descriptor, companion code, modifier, setting, or provider-type condition.
- Check effective dates, revisions, exclusions, and transition instructions.
- Record the source, version, retrieval date, and reviewer; escalate ambiguity officially.
What not to assume
A code match is not full applicability
Geography, beneficiary, setting, timing, exemptions, and other factors still matter.
Selection is not noncoverage
Being selected for review does not itself state the clinical outcome, coverage, or payment result.
Enhanced technology/AI assistance can help compare codes and source text, but cannot replace code validation or the human clinical determination. WISeRly’s output is preparation only.
Authority
CMS WISeR model page and current materials
CMS WISeR Provider and Supplier Guide v7.0 (PDF)
Use synthetic codes and fictional cases in public demos. Do not enter beneficiary identifiers, records, claims, or other PHI.