WISeR denial in Arizona: your appeal date

What WISeR covers in Arizona

For Original Medicare services given in Arizona on or after January 15, 2026, WISeR prior authorization requests go to Zyter Inc. (requests accepted since January 5, 2026), with Noridian as the Medicare contractor.

The CMS, WISeR Model page (page last modified September 30, 2026) names Arizona as a WISeR state, with Zyter Inc reviewing requests. These services need prior authorization, or review before payment, when given in Arizona:

• Arthroscopic lavage and debridement for the osteoarthritic knee
• Induced lesions of nerve tracts
• Vagus nerve stimulation
• Phrenic nerve stimulators
• Electrical nerve stimulators
• Incontinence control devices
• Sacral nerve stimulators for urinary incontinence
• Diagnosis and treatment of impotence
• Percutaneous vertebral augmentation for vertebral compression fracture (kyphoplasty, vertebroplasty)
• Epidural steroid injections for pain management
• Cervical fusion
• Hypoglossal nerve stimulation for obstructive sleep apnea

Skin substitutes are off the list in Arizona. The CMS guide says Noridian will not review them there, because the coverage policy was withdrawn.

The list is the one in the CMS, WISeR Provider and Supplier Operational Guide, version 7.0 (last updated July 24, 2026). Two more services are named and delayed until a future year. They are deep brain stimulation and percutaneous image-guided lumbar decompression for spinal stenosis. It counts where the service is given, in Arizona, and only in Original Medicare: CMS says Medicare Advantage is out.

Non-affirmed is not denied: the three moments

Moment 1: the non-affirmed letter. This is the letter WISeR sends, and it is never appealable on its own. Section 10 of the CMS guide says it "is not an initial determination on a claim for payment". Your provider can resubmit it, with no limit under section 4.4 of the guide, adding what the letter says was missing. At the same time your provider can ask Zyter Inc. for a peer-to-peer review. A human clinician with relevant clinical expertise must review every non-affirmation before it is sent, CMS says.

Moment 2: the ABN. If the service goes ahead anyway, the CMS guide says your provider should first give you an Advance Beneficiary Notice. The Medicare Appeals booklet spells out the boxes. Option 1 asks the provider to bill Medicare, and you keep the right to appeal a denial. Option 2 asks them not to bill Medicare, and then you cannot appeal. You should tick Option 2 only if you are sure: it is the box that gives up the appeal.

Moment 3: the claim decision on your Medicare Summary Notice. A denial there is the first thing you can appeal. You have 120 days from receipt, and CMS presumes receipt 5 calendar days after the notice date. No minimum dollar amount applies at this first level. The rule is 42 CFR 405.942 (govinfo copy). It counts a request as filed on the day the contractor receives it, so send it early. The contractor generally decides within 60 days.

What the released records show

CMS says WISeR companies plan to answer a request within 3 calendar days (CMS operational guide, section 4; the CMS FAQ says three days). The Electronic Frontier Foundation published records it obtained from CMS on September 8, 2026. Two of the companies denied 5,944 prior authorization requests in the first 3 months of the program. One request went unanswered for 83 days.

That 5,944 is a count from CMS status reports, never a denial rate for Arizona and never a prediction for your case.

The free route, in order

1. Keep the non-affirmation letter and, later, the Medicare Summary Notice, which names the contractor that hears your appeal.
2. Ask your doctor for a letter that answers the coverage criteria for your service. The CMS operational guide, version 7.0, lists the records the reviewer looks for.
3. File the redetermination in writing, on form CMS-20027, with the contractor on your notice (Noridian for WISeR in Arizona). A letter works too, if it carries your name, Medicare number, the service, its date and why you disagree.
4. Free help: your State Health Insurance Assistance Program gives free one-to-one counseling, including on appeals (shiphelp.org). 1-800-MEDICARE answers questions too.

This route needs nothing from denialfacts.

Questions about WISeR in Arizona

Other WISeR states: WISeR in New Jersey · WISeR in Ohio · every WISeR state, and the deadline step.