Anesthesia practices are facing some of the steepest reimbursement pressure in healthcare. Years of CMS cuts, payer policies and new federal rules have compressed margins even as demand and costs rise.
Here are 10 key notes on where anesthesia reimbursement stands near the end of 2025:
1. Average professional anesthesia reimbursement has fallen 5.5% since 2019: Anesthesia reimbursement averaged $21.88 per unit in 2023, a 5.5% drop from 2019. Medicare rates show the same pattern, falling from $22.27 in 2019 to $21.12 in 2023.
2. The 2025 CMS anesthesia conversion-factor cut is widening operational margin gaps: CMS finalized a 2.83% cut to the anesthesia conversion factor for 2025, adding financial strain at a time when labor costs for anesthesiologists and CRNAs continue to rise. Leaders say the squeeze is especially difficult for hospitals and ASCs already facing subsidy growth and staffing shortages.
3. Inflation-adjusted anesthesia payments for select procedures have fallen for decades: Over the last 23 years, inflation-adjusted Medicare reimbursement for key pain procedures has dropped an average of 2.81% annually, reflecting a long-term structural decline that predates today’s pressures.
4. Payers are tightening claims reviews, increasing denials, delays and pullbacks: Insurers are intensifying scrutiny of anesthesia claims, issuing denials for “time discrepancies,” reprocessing claims months later to pull back payment and rejecting bills over modifier interpretation. Leaders say these tactics extend the revenue cycle and reduce net collections.
5. Commercial payers are bundling more anesthesia services, reducing separate payment: Some carriers are bundling regional anesthesia services, such as nerve blocks, into base anesthesia charges, eliminating previously billable add-ons. Practices say bundling effectively lowers reimbursement without formally announcing a rate cut.
6. Some payers have implemented significant cuts to independently practicing CRNAs: 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. These changes mean independent CRNAs receive lower reimbursement than physician-billed cases and may no longer be compensated for higher-complexity care.
7. The No Surprises Act has in some markets driven anesthesia payments down sharply: Although designed to protect patients from unexpected bills, the No Surprises Act has had reimbursement consequences for anesthesia groups, with payments falling by nearly 40% in some instances. This has created significant financial pressure for practices already strained by rising costs and workforce shortages.
8. Shrinking reimbursement is worsening an already severe workforce shortage: The anesthesia workforce is contracting, with more than 2,800 anesthesiologists leaving the field in one year and more than half of practicing anesthesiologists now older than 55. Reimbursement declines are exacerbating these shortages, adding financial strain to a specialty already facing high retirement rates and growing clinical demand.
9. ASCs are increasingly turning to anesthesia stipends as financial pressures mount: The share of ASCs expecting to pay anesthesia stipends rose from 28% in 2024 to 44% in 2025, driven by staffing shortages, rising anesthesia salaries and stagnant reimbursement.
Stipends are becoming necessary even for facilities that never needed them before, not only because of workforce gaps, but because the traditional ASC financial model is growing harder to sustain. Some warn the trend could push financially strained facilities, especially in rural markets, toward consolidation or closure.
10. Financial strain may leave some anesthesia practices and facilities unable to stay viable: Anesthesia leaders warn that declining reimbursement, rising wage inflation and structural inefficiencies in procedural care are creating an environment in which some practices and facilities, particularly rural hospitals and financially strained ASCs, may be unable to negotiate sustainable rates or maintain operations.
As inefficiencies and stipend pressures intensify, experts have predicted the system will produce “winners and losers,” with vulnerable facilities and smaller anesthesia practices facing the greatest risk.
