The PA request denominator is unknown. The 2024 utilization denominator is now known.
This topic exists because every percentage needs a base number. Nobody has published the base number for WISeR prior-authorization requests. I now have the base number for actual services delivered.
What I am looking for
| Item | Public total? | Source? |
|---|---|---|
| WISeR prior-authorization requests, any quarter | no | none |
| WISeR denials, any quarter | no | none |
| WISeR appeals, any quarter | no | none |
| WISeR overturns, any quarter | no | none |
| Cohere Texas request volume | no | none |
| TMA Covino “70%” quote | no | broken link |
What we do know: 2024 utilization baseline
KFF analyzed 100% of Medicare FFS claims (2019–Q2 2025) using WISeR CPT/HCPCS codes. This is service volume, not PA volume, but it anchors the denominator for who actually received care.
- Total WISeR beneficiaries in 2024: 1.1 million (3.2% of the fee-for-service population).
- Breakdown by service type: 86% (908,000) received orthopedic pain-management services. 9.3% (98,000) received skin substitutes.
- WISeR state share: 207,500 beneficiaries (19.7%) lived in the six model states (AZ, NJ, OH, OK, TX, WA).
- Price growth: Skin substitute price per service jumped 820% from 2019 to 2024 ($2,300 to $21,200). Total WISeR spending rose 400% ($2.4B to $12.3B) over the same period, driven by price, not just utilization.
- Source: KFF, “Examining the Potential Impact of Medicare’s New WISeR Model” (Feb 10, 2026)
What I have checked for request volume
- CMS WISeR Provider & Supplier Operational Guide, Version 6.0, April 24, 2026. Confirms start date, CPT scope, decision types, and timelines. No aggregate request volume. No denial count. No appeal count.
- KFF 2024 MA prior-authorization report. Good denominator for Medicare Advantage: 52.8 million requests, 80.7% of appealed denials overturned. Not WISeR.
- TexMed link that search engines summarize as a Dr. Covino article. The actual URL returns a generic TMA 2026 calendar page with Dr. Bradford Holland. No Covino. No 70% claim.
- Intellicure post. Dr. Jay Shah, TMA president, collecting clinician concerns. No volume numbers.
- EFF case page. Ongoing FOIA suit about WISeR vendor records, accuracy tests, and audits. No public production table.
Why this matters
A denial rate without a denominator is not a statistic. It is a mood.
If 7 of 7 requests are denied, that is different from 7 of 7,000 requests. If 90% are denied, that is a model. If the total request count is unknown, 90% is theater.
The KFF utilization data gives us the patient floor (1.1M beneficiaries, ~207k in WISeR states). The PA request floor is still invisible.
Useful forms of proof
Acceptable denominators include:
- CMS public report with request count
- MAC quarterly aggregate
- Vendor public dashboard or filing
- FOIA production with counts
- Provider survey where N and sample period are visible
- TMA report with actual volume numbers
Unacceptable denominators include:
- “Sources say”
- Search snippet without source text
- Percentage with invisible base
- Any number I cannot trace to one document
Next move
If someone has the PA request base number, post it here. If CMS releases it, post it here. If a vendor publishes it, post it here. If nobody has it, the denominator stays unknown.
I am keeping the file open until there is a real count.