Anesthesia reimbursement faces mounting threats, with new and proposed payer policies that could reduce pay for physicians and CRNAs in 2025 and beyond.
The changes span commercial and government payers, targeting modifiers, time-based payments and risk adjustments — policies that could squeeze margins and alter care delivery models.
Industry groups say the impact could extend beyond provider income, affecting patient access and incentivizing care shifts away from high-acuity or underserved settings.
“This cut singles out CRNAs despite using the same techniques as other anesthesia providers,” American Association of Nurse Anesthesiology President Jan Setnor, MSN, CRNA, told Becker’s. “It’s unacceptable, especially amid a national shortage of anesthesia providers.”
Here are five things to know:
- UHC’s CRNA reimbursement cut takes effect Oct. 1
UnitedHealthcare will reduce payments for independently practicing CRNAs by 15% under the QZ modifier, excluding a handful of states. It will also end payments for certain physical status modifiers and qualifying circumstances such as emergencies. - Risk-adjusted pay disappearing
The same UHC policy removes additional reimbursement for higher-acuity patients. The ASA warns that this may disincentivize care for sicker patients and undervalue the complexity of their needs. - CMS cuts continue
For 2025, CMS finalized a 2.2% reduction to the anesthesia conversion factor, bringing it to $20.3178. While a slight bump is proposed for 2026, offsets like a -2.5% efficiency adjustment could negate gains. - Payer “cost-shifting” tactics
Commercial insurers are increasingly removing ASA modifiers, extending claim arbitration timelines, and shifting anesthesia costs into bundled surgical payments — moves that can quietly erode reimbursement over time. - A hidden legislative shift in New York could allow time caps on anesthesia Amendments added to New York State Assembly Bill A5375‑A and Senate Bill S7918‑A include a so-called “hidden clause” enabling insurers to impose predetermined time limits on anesthesia care during surgeries. The ASA strongly opposes the maneuver, warning that it allows payers to undercut medically necessary care.