CMS has finalized a 1.91% cut to the Medicare anesthesia conversion factor for 2027, deeper than the 1.38% reduction it proposed in July.
The final rate is $20.1056, down from $20.4976 in 2026, under the 2027 physician fee schedule final rule released Nov. 4. For anesthesia providers who qualify through advanced alternative payment models, the rate falls 1.42%, to $20.3068 from $20.5998. CMS had proposed $20.2143 and $20.4165.
The cut mainly reflects the expiration of a one-year 2.5% increase Congress authorized for 2026.
In the proposed rule, CMS said that “effectively means that current law requires -2.50% reduction in Medicare payment” compared with 2026. Statutory updates of 0.25% for most physicians and 0.75% for qualifying APM participants partly offset it, along with an estimated -0.12% adjustment for changes in work RVUs, according to a CMS fact sheet.
Medicare pays anesthesia by adding the procedure’s base units to one time unit per 15 minutes, then multiplying by the conversion factor. CMS left anesthesia base units unchanged for 2027.
Here is how the final rate changes national payment for four common ASC cases, using example anesthesia times:
| Anesthesia code | Units (example time) | 2026 payment | 2027 final | Change per case |
| Lumbar spine fusion (00670) | 25 (180 min) | $512.44 | $502.64 | -$9.80 |
| Total knee replacement (01402) | 15 (120 min) | $307.46 | $301.58 | -$5.88 |
| Colonoscopy (00811) | 6 (30 min) | $122.99 | $120.63 | -$2.35 |
| Cataract surgery (00142) | 5 (15 min) | $102.49 | $100.53 | -$1.96 |
The cut applies to the full allowance when an anesthesiologist or a certified registered nurse anesthetist works alone. Under medical direction, each provider’s 50% share falls by half these amounts.
The final rule also changes several other policies:
1. Same-day E/M visits: CMS scaled back its proposed cut for office/outpatient E/M visits billed on the same day as a procedure. The reduction now applies only to visits on the same day as a 0-day global procedure, and the lower-valued service is paid at 80%. CMS had proposed paying it at 50% and including 10- and 90-day globals.
2. Quality reporting: Traditional MIPS will end after the 2030 performance year, and MIPS Value Pathways will take over starting in 2031, according to the American Hospital Association.
In its September comments on the proposal, ASA said the update “falls far short of keeping pace with rising practice costs, workforce expenses, and inflation.”
The broader physician fee schedule conversion factor falls 2.31% for most physicians, to $32.63.
The cut comes as many ASCs already subsidize anesthesia coverage. In a third-quarter survey from the Ambulatory Surgery Center Association, 31% said they offer financial assistance in anesthesia contracts, about the same as in 2024.
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