Several recent updates to reimbursement policies by both CMS and commercial payers could have a significant impact on ASCs and their financial stability
UnitedHealthcare cuts CRNA reimbursements
On Oct. 1, a UHC policy update went into effect that cuts reimbursements to certified registered nurse anesthetists by 15%.
The policy update was issued on July 1 and 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 new reduction.
The update has drawn criticism from the American Association of Nurse Anesthesiology, who told Becker’s in an Oct. 1 email that the policy “threatens patient care” and could lead to delayed procedures and strained access to care.
A white paper from Medicus Healthcare Solutions suggests the negative consequences of this policy will be amplified in rural and underserved communities, many of which rely heavily on CRNAs for perioperative care. The paper found that 75% of CRNAs reported practicing without physician oversight, as of 2023. Additionally, CRNAs now account for over 80% of anesthesia providers in rural counties and administer more than 50 million anesthetics annually in the U.S., according to the report.
“Lower reimbursement could make it harder for these centers to recruit and retain anesthesia providers, leading to delays, canceled cases, or reduced surgical capacity, especially where physician anesthesiologists are scarce,” Krista Bragg, DNP, CEO of Philadelphia-based KB Kinetics, told Becker’s.
“UnitedHealthcare is one of the nation’s largest private insurers, so this decision could prompt other payers and possibly CMS to consider similar reimbursement reductions,” she added.
CMS’ proposed rules for 2026
CMS recently proposed rules for 2026 included a 2.4% bump in pay for ASCs, which has been applauded by many ASC leaders, including the Ambulatory Surgery Center Association.
“The proposed expansion in surgical procedures that may be performed in ambulatory surgery centers reflects our longstanding belief that the clinical judgment of the medical community is the proper determinant for where patients can receive their care,” ASCA CEO Bill Prentice said in a July 15 news release. “This approach, if finalized, will allow many more Medicare beneficiaries to receive safe and effective care in surgery centers and lower costs for both patients and the Medicare program.”
Other well-received elements of the proposal included the addition of more than 200 procedures to the covered procedures list for ASCs and increased payment for supplies.
“The proposal would also pay surgery centers separately for advanced wound care supplies, improving reimbursement and access to biologic treatments for complex wounds,” Ms. Bragg said. “Together, these changes support the broader shift toward site-neutral payments, where hospitals and surgery centers are paid the same rate for identical services. That shift could make care more affordable for patients and strengthen the long-term sustainability of ASCs, although hospitals may face lower outpatient reimbursement as volumes shift.”
Increased payer support for outpatient cardiology
Cardiology was one specialty that saw significant expansion in the ASC-CPL list proposal, supporting the continued growth of the specialty in ASCs and outpatient settings.
“The addition of EP ablation is a big win for cardiology,” said Tracy Helmer, administrator of Mesa, Ariz.-based Tri-City Surgical Centers told Becker’s. “There’s been a lot of work with that over the last number of years to show the efficacy and safety profile for those particular procedures.”
Kristen Richards, vice president of ambulatory care at Cardiovascular Logistics, told Becker’s that the move has sparked momentum in the space — but it will take time for providers, payers and patients to become fully aligned.
“I think part of that is going to be driven by payers, because they’re going to push the patients to these lower-cost settings to provide care that is as equal as doing it in the hospital,” she said. “The care being delivered in the ASCs is demonstrating that the quality metrics and the patient experience in the ASC outperforms the hospitals.”
