11 moves for practices caught in Medicare's AI prior auth pilot

Epidural steroid injections fell 15 percent in the six states testing Medicare's AI-enabled prior authorization pilot, compared with trends in the rest of the country, according to a research letter published Oct. 26 in JAMA. Other targeted services fell about 20 percent.

The drop came fast. For injections, it eased from about 21 percent in the first quarter of 2026 to about 9 percent in the second, while other services moved only from 21 percent to 18 percent. Services slated for the pilot but never implemented showed no significant decline. The University of Minnesota's summary says the easing may reflect workflow problems getting solved, clinicians learning the rules or both. What the authors can't say is whether the missing care was wasteful or necessary.

That answer may take years. CMS' WISeR model runs through 2031 in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington. For practices there, the gap between those two quarters is the useful part, because it suggests some of the drop may come down to process. Here are 11 places to start.