A wave of payer anesthesia policy changes — capping billable time, cutting CRNA rates and penalizing facilities for using out-of-network clinicians — is intensifying financial pressure on practices already contending with rising overhead.
Legislators and physician associations are pushing back, but several policies have taken effect regardless. Here are three controversies defining the debate:
Anesthesia time limit bans
The fight over payer-imposed time limits on anesthesia reimbursement has escalated steadily since late 2024, when Anthem Blue Cross Blue Shield proposed capping reimbursement based on procedure duration in Missouri, New York and Connecticut. The proposal ignited a legislative backlash across multiple states.
Washington state lawmakers reintroduced a bill on January 29 that would prohibit insurers from denying coverage or capping reimbursement based on how long anesthesia is used during a procedure. House Bill 1812, sponsored by Rep. Alicia Rule, applies to health carriers offering plans to public employees, including Medicaid plans and those administered by the Washington Health Care Authority. If passed, the bill would eliminate time caps on anesthesia reimbursement and establish enforcement authority for the Office of the Insurance Commissioner, including monetary penalties, claim repayment and potential license suspension or revocation. Violations would be published on the agency’s website. Maryland and Illinois have already enacted similar bans.
Despite this pushback, Anthem moved forward. Effective February 1, 2025, the insurer revised its policy for commercial plans in Connecticut, New York and Missouri, calculating allowable anesthesia time based on CMS physician work time values rather than actual documented procedure time. The change applies to claims billed under CPT codes 00100 through 01999 and could result in denials when procedures exceed preset time thresholds.
UnitedHealthcare reduces QZ-billed CRNA reimbursement.
In October, UnitedHealthcare cut reimbursement for QZ-billed CRNA services by 15% in select states and eliminated payments tied to several add-on and qualifying-circumstance codes. Because QZ billing reflects CRNA services delivered without physician medical direction, the reduction directly lowers compensation for independent CRNAs and may eliminate pay for higher-acuity cases entirely.
The move compounds existing financial strain on anesthesia practices.
“Continued decrease in reimbursement certainly puts a strain on anesthesia practices at a time when overhead continues to increase,” Jason Habeck, MD, assistant professor of anesthesiology at the Minneapolis-based University of Minnesota, told Becker’s
Elevance/Anthem adds facility penalties tied to out-of-network clinicians.
Several major physician associations are calling on Elevance Health to scrap a new policy that penalizes hospitals and contracted facilities for using clinicians who are out of network with Anthem Blue Cross Blue Shield commercial plans across 11 states.
Finalized Oct. 1 and effective Jan. 1, 2026, the policy imposes an administrative penalty equal to 10% of the allowed amount on any facility claim that involves a nonparticipating provider. Facilities are barred from passing that cost on to patients, and repeated use of out-of-network clinicians could result in termination from Anthem’s network altogether.
In a joint letter, the American Society of Anesthesiologists, the American College of Emergency Physicians and the American College of Radiology urged Anthem to withdraw the policy.
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