Anesthesia providers are facing significant reimbursement challenges in 2024, with cuts coming from both private insurers and federal policy changes.
Leaders argue these reductions could impact care delivery, financial sustainability for hospitals and ASCs, and access to anesthesia services across the country. Here are the three cuts to anesthesia reimbursement and pay in 2024:
1. Anthem Blue Cross Blue Shield health plans in Ohio, Missouri, Connecticut, New York, Nevada and Maine have reduced reimbursement for QZ services — those performed by certified registered nurse anesthetists without medical direction by a physician — to 85% of the physician fee schedule effective Nov. 1.
The move sparked criticism from the American Association of Nurse Anesthesiology, which said the move will affect treatment in rural and underserved areas.
"We believe Anthem's new anesthesia reimbursement policies are in violation of existing federal laws regarding provider nondiscrimination in commercial health plans, encourage higher-cost healthcare delivery without improving quality, and may impair access to care," the organization said in an Aug. 6 news release. "AANA urges that Anthem Blue Cross and Blue Shield rescind these policies and promote access to CRNA anesthesia services."
2. Anthem BCBS is also rolling out another major policy revision effective Feb. 1, 2025, for health plans in Connecticut, New York and Missouri. Under this policy, Anthem will calculate allowable anesthesia time for claims based on CMS physician work time values rather than actual time spent providing care.
This change applies to anesthesia claims under CPT codes 00100 through 01999 and will result in denials for claims exceeding predetermined time limits. Anesthesiologists and CRNAs argue this shift will undermine fair reimbursement and complicate billing, especially for complex cases requiring longer durations.
"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.
3. In addition to private payer cuts, CMS finalized a 2.83% reduction in the physician fee schedule for 2025, with the conversion factor dropping from $33.29 in 2024 to $32.35. This cut, part of the 2025 Medicare Hospital Outpatient Prospective Payment System and ASC Payment System, compounds financial pressures on anesthesia practices that rely heavily on Medicare reimbursements.
"These cuts will also continue to erode physicians' autonomy in delivering healthcare to U.S. citizens, making them more reliant on healthcare systems to employ them," Rick Richter, MD, anesthesiologist at Anesthesia Associates of Rock Hill (S.C.), told Becker's. "Moreover these cuts will continue to have a devastating impact on the private practice physician model in the US and may very well drive it to extinction. Overall, I believe it will eventually have a negative impact on the overall health and wellbeing of community health in the U.S."