ASCs face numerous challenges when it comes to anesthesia costs and management as reimbursement cuts and payer pushback add pressure to existing staffing and economic issues.
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 for Physician Leadership.
“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.
The 2025 Medicare Physician Fee Schedule proposes another 2.83% cut to the anesthesia conversion factor.
“Medicare and Medicaid rates are already unsustainably low,” Cory Maxwell, MD, of Charlotte, N.C.-based Providence Anesthesiology Associates, told Becker’s. “This system forces commercial payers to subsidize government payers, leaving practices highly sensitive to shifts in payer mix.”
New methods for increasing denials, delays
Some ASC leaders have said that payers are becoming increasingly creative — or aggressive — in their tactics for denying or delaying anesthesia payments.
“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),” Katy Dean, CRNA, chief nurse anesthetist at Newport News, Va.-based TKM Anesthesia, told Becker’s.
Improperly bundled services and prior authorization are also methods that payers have used to reduce anesthesia reimbursements, Ms. Dean said.
“For example, if I do a regional nerve block for pain control after surgery, insurers often say that’s included in the anesthesia charge, when it’s not. That block requires separate expertise, time and documentation,” she said. “Prior authorization is becoming a major barrier too. Even for routine procedures or pain management, insurers are demanding approvals in advance, and if you don’t jump through their hoops, they’ll deny the claim after the fact, regardless of medical necessity.”
UnitedHealthcare slashes CRNA reimbursements
On Oct. 1, a new UnitedHealthcare policy went into effect, cutting reimbursements to certified registered nurse anesthetists by 15%.
Announced July 1, the policy applies to claims for anesthesia services rendered by CRNAs practicing independently. For claims billed under the QZ modifier — those rendered by CRNAs — the provider will now receive 85% of the allowable.
CRNAs in Arkansas, California, Ohio, Colorado, Hawaii, Massachusetts, New Hampshire and Wyoming are exempt from the reduction.
The change has drawn criticism from the American Association of Nurse Anesthesiology, which told Becker’s in an Oct. 1 email that the policy “threatens patient care” and could lead to delayed procedures and strained access — especially in rural and underserved areas where CRNAs are more commonly used.
The AANA also argues the policy violates a provider nondiscrimination provision in the ACA. The group said it has submitted a coalition letter urging the secretaries of the departments of Labor, HHS and Treasury to investigate and stop commercial payers from violating the provision.
