Anesthesia providers are facing mounting reimbursement cuts and payer pushback, but recent payer reversals and state-level protections suggest the tide isn’t entirely against them.
Reimbursement rates on a steady decline
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.
Providers are feeling the pinch.
“There’s going to be a breaking point for smaller companies like mine …. Unless things change, this entire system will likely hit a breaking point within five years,” Brian Cross, CRNA, owner of Youngstown, Ohio-based CS Anesthesia, told Becker’s.
Payer pressure intensifying
Reimbursement declines are being compounded by more aggressive payer tactics.
“Insurers are getting more aggressive, and more creative, in avoiding payment,” Katy Dean, CRNA, chief nurse anesthetist at Newport News, Va.-based TKMAnesthesia, told Becker’s. “We’re seeing more denials for time discrepancies, claims being reprocessed months later with money pulled back, and even outright rejections for technicalities like modifier confusion (the codes that show who provided care).”
UnitedHealthcare cuts CRNA reimbursements
In July, UnitedHealthcare eliminated physical status modifiers, codes reflecting patient complexity, from anesthesia reimbursement calculations. These modifiers help account for increased risk and skill.
The ASA criticized the change, stating it ignores the foundational principle of individualized patient care. ASA President Dr. Donald Arnold said “It’s shameful that insurers are padding their profits at the expense of payments for those providing important care to complicated patients.”
UnitedHealthcare also removed payments for certain CPT add-ons and cut reimbursements by 15% for independently practicing CRNAs, effective Oct. 1.
CRNA leaders have warned these changes could cause delayed procedures, longer travel for patients, and exacerbated staffing shortages in rural and underserved areas.
AANA President Janet Setnor, CRNA, MSN, called the policy “discriminatory toward independent CRNAs” and said it “doesn’t benefit the patients.
The No Surprises Act
The No Surprises Act, implemented in January 2022, aimed to prevent surprise billing by creating an independent dispute resolution process. But anesthesia providers say loopholes remain.
Antonio Hernandez Conte, MD, former president of the California Society of Anesthesiologists, told Becker’s insurers frequently delay payments for 90–120 days, even after groups win arbitration.
While providers often win disputes — 83–88% of cases in early 2024, according to Health Affairs — the process is time-intensive, geographically uneven, and often requires legal counsel, burdening smaller practices.
Good news
Payers backtrack on cuts
Some payers are retreating under pressure.
Anthem Blue Cross Blue Shield reversed a proposed policy that would have capped anesthesia billing based on CMS physician work-time values, which would have denied claims exceeding preset limits.
Kaiser Foundation Health Plan also walked back a Washington state policy that would have denied reimbursement without certain modifiers and cut CRNA payments for QZ services to 85% of the physician fee schedule.
Banning time limits on anesthesia reimbursements
Legislators are stepping in. In Illinois, Gov. J.B. Pritzker signed a law banning reimbursement caps on anesthesia time, requiring insurers to cover the full duration of procedures. Washington legislators proposed similar bipartisan protections.
Support for the No Surprises Enforcement Act
In July, the ASA and other major societies backed the No Surprises Enforcement Act, which would penalize insurers that lowball payments and lose arbitration by requiring them to pay triple the difference plus interest. Advocates argue this would level the field for providers in IDR disputes.
