Eight months after UnitedHealthcare cut certified registered nurse anesthetist reimbursement by 15%, the financial burden unleashed on ASCs is still building.
The UHC cut applies to QZ-billed CRNA services in selected states and eliminates payments tied to several add-on and qualifying-circumstance codes. Because QZ billing reflects CRNA services delivered without physician medical direction, the reduction directly lowers compensation for independent CRNAs and may eliminate pay for higher-acuity cases entirely.
ASCs are already stretched on anesthesia costs. The share of ASCs expecting to pay anesthesia stipends rose from 28% in 2024 to 44% in 2025, driven by staffing shortages, rising anesthesia salaries and stagnant reimbursement.
The UHC cut puts more pressure on ASCs’ anesthesia stipends. When reimbursement falls, anesthesia groups serving ASC markets face two choices: absorb the loss or renegotiate their arrangements with the facilities they cover. For independent groups without the contract leverage of large nationals, the renegotiation conversation typically goes one direction.
Mo Azam, MD, head of innovation at Orlando, Fla.-based US Anesthesia Partners, has warned that stipends are fueling an unsustainable “arms race,” with facilities potentially reducing low-margin services, limiting OR time or closing when coverage cannot be secured.
“The biggest disruption will be the growing mismatch between anesthesia workforce capacity and procedural demand, amplified by flat reimbursement and increasingly restrictive payer policies,” Megan Friedman, DO, chair and medical director at Los Angeles-based Pacific Coast Anesthesia, told Becker’s.
The UHC cut did not arrive in a vacuum. Average professional anesthesia reimbursement fell by 5.5% from 2019 to 2023. CMS finalized a 2.83% cut to the physician conversion factor for 2025, adding further strain as labor costs for anesthesiologists and CRNAs rise.
“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 Minneapolis-based University of Minnesota, told Becker’s.
The pattern extends beyond rate cuts.
“Insurers are getting more aggressive, and more creative, in avoiding payment,” Katy Dean, CRNA, chief nurse anesthetist at Newport News, Va.-based TKMAnesthesia, told Becker’s. “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).”
ASCs that rely on independent CRNA coverage, particularly in markets where physician anesthesiologists are scarce, face a direct threat to OR utilization if anesthesia groups reduce their footprint or exit UHC networks.
“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.”
The American Association of Nurse Anesthesiology has argued the policy “threatens patient care” and could lead to delayed procedures and strained access to care, particularly in rural and underserved communities where CRNAs are more heavily utilized. The organization filed a coalition letter Oct. 1 urging the Departments of Labor, HHS and Treasury to investigate whether the UHC policy violates the ACA’s provider nondiscrimination provision