Payers are quietly reshaping the economics of anesthesia — and ASCs are feeling the effects first.
With new reimbursement cuts and policy shifts eliminating key modifiers, anesthesia has become one of the most unpredictable financial pressures.
UnitedHealthcare’s 15% pay cut for independently practicing CRNAs in selected states, which took effect Oct. 1, removes long-standing payments for physical status modifiers and qualifying circumstance codes, reducing compensation even for complex procedures.
This comes after years of declining rates: between 2019 and 2024, CMS anesthesia reimbursements fell by 8.2% from $22.27 per unit to $20.44.
“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.
The 2025 Medicare Physician Fee Schedule includes another 2.83% reduction to the anesthesia conversion factor.
“Medicare and Medicaid rates are already unsustainably low,” Cory Maxwell, MD, of Charlotte, N.C.-based Providence Anesthesiology Associates, told Becker’s. “This system forces commercial payers to subsidize government payers, leaving practices highly sensitive to shifts in payer mix.”
For ASCs, these reimbursement cuts land amid an industry expansion into higher-acuity specialties such as orthopedics, spine and cardiology — which demand longer anesthesia times and greater risk management.
“Demand for anesthesiologists is growing, yet reimbursement keeps dropping, which puts pressure on hospitals and ASCs to make up the difference,” David Vierra, MD, of Providence Medical Group–Napa (Calif.), told Becker’s.
All the while, anesthesia compensation continues to climb as shortages persist. The widening gap between rising costs and falling reimbursement is forcing many centers to revisit anesthesia agreements and integrate financial alignment into long-term strategy.
Some ASCs are renegotiating contracts or forming joint-venture models to stabilize coverage and share risk.
“Given looming Medicare cuts and increasing Medicaid volumes, the viability of local private practice groups — the bedrock of community hospitals — is being called into question,” Vijay Sudheendra, MD, president of Narragansett (R.I.) Bay Anesthesia, told Becker’s.
Technology may help offset some of the pressure. AI-driven scheduling, pre-operative automation and predictive analytics tools, for example, are all helping anesthesia teams streamline operations and track profitability.
As reimbursement continues to tighten, anesthesia alignment is emerging as a top strategic priority for ASC leaders.
Centers that view anesthesia as a strategic partner — through shared governance, transparency and joint investment — will be positioned to sustain profitability and protect access to outpatient surgery as economic pressures deepen.
