The fight over how long anesthesia can run during surgery has produced a fragmented regulatory landscape featuring a patchwork of state bans, proposed bills and active payer policies that vary across markets.
The tug-of-war escalated in late 2024, when Anthem Blue Cross Blue Shield proposed capping reimbursement based on procedure duration in Missouri, New York and Connecticut, igniting legislative backlash across multiple states. In February 2025, Anthem revised its policy, calculating allowable anesthesia time based on CMS physician work time values rather than actual documented procedure time. The change applies to claims billed under CPT codes 00100 through 01999 and could result in denials when procedures exceed preset time thresholds.
The policy was narrow in its initial scope but broad in its implications.
“I think the Anthem decision to reimburse on CMS average minutes rather than actual minutes will further deteriorate anesthesia reimbursement, leading to further pressure on hospitals and ASCs to make up the difference, more anesthesiologists leaving medicine and further reductions in access to care,” David Vierra, MD, an anesthesiologist with Providence Medical Group-Napa (Calif.), told Becker’s.
The legislative response has been significant but uneven. Illinois enacted legislation in August prohibiting insurers from setting time limits on anesthesia coverage, requiring reimbursement for the entire duration of procedures. Maryland enacted a similar ban, and comparable proposals have moved forward in Washington and New Jersey.
Washington state lawmakers reintroduced a bill on Jan. 29 that would prohibit insurers from denying coverage or capping reimbursement based on how long anesthesia is used during a procedure. If passed, the bill would eliminate time caps on anesthesia reimbursement and establish enforcement authority for the Office of the Insurance Commissioner, including monetary penalties, claim repayment and potential license suspension or revocation. Violations would be published on the agency’s website.
The legislative map cuts both ways. Amendments added to bills in the New York State Assembly and Senate include a so-called “hidden clause” enabling insurers to impose predetermined time limits on anesthesia care during surgeries. The American Society of Anesthesiologists strongly opposed the maneuver, warning that it allows payers to undercut medically necessary care.
Lawmakers in Missouri have also introduced bills to strengthen oversight of insurer reimbursement practices, following backlash over policies that attempted to restrict anesthesia coverage.
The time cap fight obscured a separate Anthem policy with direct ASC implications. Finalized Oct. 1 and taking effect Jan. 1, 2026, the policy imposes an administrative penalty equal to 10% of the allowed amount on any facility claim that involves a nonparticipating provider. Facilities are barred from passing that cost on to patients, and repeated use of out-of-network clinicians could result in termination from Anthem’s network. The American Society of Anesthesiologists, the American College of Emergency Physicians and the American College of Radiology urged Anthem to withdraw the policy.
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.