Anesthesia reimbursement is declining across the board, and providers say the financial strain is becoming unsustainable.
Anesthesia reimbursements are taking a huge toll on providers. The average anesthesia reimbursement rate in 2023 was $21.88 per unit, a 5.5% decline from 2019, according to Coronis Health. Similarly, Medicare reimbursement fell from $22.27 per unit in 2019 to $21.12 in 2023, a trend highlighted in a VMG report.
Longer-term trends are equally troubling. Over the past 23 years, inflation-adjusted Medicare reimbursement for select pain management procedures has decreased an average of 2.81% annually, according to the American Association of Physician Leadership.
“There’s going to be a breaking point for smaller companies like mine. I hire [certified registered nurse anesthetists] to work for me, but the costs are almost too high to justify keeping contracts with surgery centers,” Brian Cross, CRNA, owner of Youngstown, Ohio-based CS Anesthesia, told Becker’s in 2024. “These centers are going to have to increase their volume to stay viable. Right now, CRNAs and anesthesiologists expect to be paid for an eight-hour day, but if the surgery center finishes in six hours, that’s lost revenue. Unless things change, this entire system will likely hit a breaking point within five years.”
The issue took on new urgency in late 2024 when Anthem Blue Cross Blue Shield proposed a policy that would impose time limits on anesthesia reimbursement in Missouri, New York and Connecticut. The plan drew intense backlash from clinicians and lawmakers, prompting Anthem to reverse course. The payer attributed the reversal to “widespread misinformation” about the policy update.
A month later, Kaiser Foundation Health Plan also reversed an anesthesia reimbursement change it had implemented in Washington state.
Since then, several states — including Illinois, New York and Washington — have introduced or advanced legislation aimed at banning similar anesthesia reimbursement cuts. But even amid these reversals, payers continue to implement new reimbursement and payment policies that providers say reduce compensation, increase administrative burdens and threaten access to anesthesia coverage.
1. UnitedHealthcare reduces QZ-billed CRNA reimbursement.
In October, UnitedHealthcare reduced reimbursement for QZ-billed CRNA services by 15% in selected states and removed payments tied to several add-on and qualifying-circumstance codes.
Because QZ billing reflects CRNA services delivered without physician medical direction, the change lowers reimbursement for independent CRNAs and may eliminate compensation for higher-acuity care.
“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.
2. Anthem reduces QZ reimbursement to 85% of the physician fee schedule.
In 2024, Anthem Blue Cross Blue Shield plans in Ohio, Missouri, Connecticut, New York, Nevada and Maine reduced reimbursement for QZ services to 85% of the physician fee schedule, effective Nov. 1.
The policy drew criticism from the American Association of Nurse Anesthesiology, which warned it could limit access to care, especially in rural and underserved areas.
“We believe Anthem’s new anesthesia reimbursement policies are in violation of existing federal laws regarding provider nondiscrimination in commercial health plans, encourage higher-cost healthcare delivery without improving quality, and may impair access to care,” the organization said in an Aug. 6 news release. “AANA urges that Anthem Blue Cross and Blue Shield rescind these policies and promote access to CRNA anesthesia services.”
3. Anthem adopts CMS-based time caps for anesthesia claims.
Anthem also rolled out a policy revision effective Feb. 1, 2025, affecting commercial plans in Connecticut, New York and Missouri. Under the policy, Anthem will calculate allowable anesthesia time based on CMS physician work time values, rather than the actual documented anesthesia time. The change applies to anesthesia claims billed under CPT codes 00100 through 01999 and could result in claim denials when procedures exceed preset time thresholds.
“I think the Anthem decision to reimburse on CMS average minutes rather than actual minutes will further deteriorate anesthesia reimbursement, leading to further pressure on hospitals and ASCs to make up the difference, more anesthesiologists leaving medicine and further reductions in access to care,” David Vierra, MD, an anesthesiologist with Providence Medical Group-Napa (Calif.), told Becker’s in 2024.
4. Elevance/Anthem adds facility penalties tied to out-of-network clinicians.
Several physician associations are urging Elevance Health to abandon a new policy that penalizes hospitals and contracted facilities for using clinicians who are not in network with Anthem Blue Cross Blue Shield commercial plans in 11 states.
Finalized Oct. 1 and set to take effect Jan. 1, the policy imposes an administrative penalty equal to 10% of the allowed amount on any facility claim involving a nonparticipating provider. Facilities are prohibited from passing the penalty on to patients, and repeated use of out-of-network clinicians could result in termination from Anthem’s network.
A joint letter from the American Society of Anesthesiologists, the American College of Emergency Physicians and the American College of Radiology calls on Anthem to withdraw the policy.
5. CMS cuts 2025 physician fee schedule conversion factor by 2.83%.
Outside of private payer cuts, federal payment changes are compounding private payer cuts. CMS finalized a 2.83% reduction to the 2025 physician fee schedule, dropping the conversion factor from $33.29 in 2024 to $32.35 in 2025. CMS has projected conversion factor increases for 2026, though providers remain wary of long-term reimbursement stability.
