Anesthesia reimbursement has been eroding for years, but the pace of payer-driven policy changes has accelerated sharply since 2023.
“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.
Three major moves are now compounding pressure on practices already dealing with a workforce shortage and rising labor costs.
1. UnitedHealthcare: 15% CRNA cut, plus modifier eliminations
On Oct. 1, 2025, a UnitedHealthcare policy went into effect cutting reimbursements to independently practicing certified registered nurse anesthetists by 15%. The policy applies to claims for anesthesia services billed under the QZ modifier, those rendered by CRNAs practicing without physician medical direction, who will now receive 85% of the allowable rate. CRNAs in Arkansas, California, Ohio, Colorado, Hawaii, Massachusetts, New Hampshire and Wyoming are exempt from the reduction.
The cut does not stand alone. UHC’s policy update also eliminates payments for physical status modifiers P3, P4 and P5 and removes units for qualifying circumstances codes 99100, 99116, 99135 and 99140 from its reimbursement calculations, citing CMS bundled service designations. That means independently practicing CRNAs handling higher-acuity patients, the cases that historically carried additional payment, are absorbing a compounded reduction.
The American Association of Nurse Anesthesiology called the policy discriminatory. AANA President Janet Setnor, CRNA said in a statement: “All anesthesia providers are trained in and use the exact same techniques to administer anesthesia, yet no other providers face the same cut — UnitedHealthcare is blatantly targeting CRNAs based on their licensure alone.”
“Lower reimbursement could make it harder for these centers to recruit and retain anesthesia providers, leading to delays, canceled cases, or reduced surgical capacity, especially where physician anesthesiologists are scarce,” Krista Bragg, DNP, CEO of Philadelphia-based KB Kinetics, told Becker’s. “UnitedHealthcare is one of the nation’s largest private insurers, so this decision could prompt other payers and possibly CMS to consider similar reimbursement reductions.”
2. Cigna: 15% cut for non-medically directed CRNA services
UnitedHealthcare’s move followed a precedent Cigna set two years earlier. Effective March 12, 2023, Cigna reduced reimbursement for claims submitted with the QZ modifier, indicating a non-medically directed CRNA service, by 15%, bringing payment to 85% of the allowable rate. The cut shifted the payment reduction to any facility that subsidizes anesthesia coverage, and risks adding a stipend burden to previously subsidy-free facilities.
According to Tony Mira, CEO of Anesthesia Business Consultants, the Cigna policy marked the first time a major national health insurance company had imposed such a position, diverging from Medicare’s standard of reimbursing CRNA services at the same level as physician anesthesiologists.
“Serious policy divergences from a major player in the market such as Cigna may have the effect of causing other significant health plans to be more willing to consider a similar policy change,” Mr. Mira wrote.
3. Aetna: Physical status modifiers eliminated
In 2024, Aetna confirmed to Becker’s that it will no longer reimburse additional unit value for anesthesia physical status modifiers for commercial plans. The change became effective for Aetna Medicare Advantage on April 1, 2024, in accordance with CMS guidelines, and was extended to commercial plans effective July 15, 2024.
Blue Cross Blue Shield plans in Texas, Oklahoma, Illinois and New Mexico — operating under Health Care Service Corporation — announced a similar elimination of physical status modifier reimbursement, effective June 1, 2024, citing CMS payment policies as the reason.
Physical status modifiers, P1 through P5, have historically added reimbursement units to reflect the complexity and risk of a patient’s condition.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.