2025 Reimbursement Trends: Feeling the Squeeze of Shrinking Reimbursements

If your anesthesia reimbursement has felt leaner lately, you’re not imagining things. Several payer “innovations” are nibbling away at reimbursement.

From cuts to QZ billing to the demise of those handy physical status and qualifying circumstance modifiers.  

Let’s unpack what’s changing and what you can do about it. 

The QZ Cut: A 15 % Discount on CRNA-Only Services 

Remember that UnitedHealthcare policy we all hoped would go the way of 8-track tapes? It hasn’t yet.  

Effective October 1, 2025, UnitedHealthcare plans to reduce reimbursement by 15% on anesthesia services billed with the QZ modifier. The policy affects all groups and facilities that use CRNA services in a non-Medically Directed model. QZ billing makes up just over 30% of all Medicare billing currently. 

Physical Status and Qualifying Circumstance Modifiers: Slowly Going the Way of the Dodo 

For decades, anesthesiology clinicians have used the American Society of Anesthesiologists’ (ASA) physical status modifiers (P1P6) and qualifying circumstance codes (e.g., 99100 for extremes of age, 99116 for total body hypothermia, 99135 for deliberate hypotension, 99140 for emergencies) to acknowledge high-risk cases. Commercial payers are increasingly refusing to pay for these add-on codes.  

Industry experts, including the AANA and ASA, have warned that UnitedHealthcare’s forthcoming policy of eliminating payment for qualifying circumstance codes and P3–P5 modifiers could disproportionally affect rural and critically underserved areas.  

Rising Denial Rates: A Growing Headache 

At the same time, claims are getting denied more often. A revenue cycle report notes that initial claim denials reached 11.8 % in 2024, up from 10.2 % just a few years earlier. 

Denials from commercial plans alone climbed 1.5 %, while Medicare Advantage denials jumped 4.8 % from 2023 to 2024. Payers are also increasingly using AI to automate reviews, resulting in large batches of incorrect denials. Those “computer says no” letters are becoming more common. 

Why It Matters for Your Practice or Facility 

Taken together, these trends squeeze margins in an already tight environment. Losing 15% on QZ billing hurts CRNA-heavy practices, and the disappearance of qualifying circumstance and physical status modifiers can reduce revenue on high complexity cases.  

Even if base unit reimbursement stays stable, more denied claims mean more staff time chasing payments that may never come. 

How to Fight Back: Practical Tips 

While we haven’t been able to stop UnitedHealthcare from tightening its purse strings, there are things that we can do to mitigate damage: 

• Chart like your auditor is watching. Detailed, accurate documentation is your first line of defense. Many denials hinge on missing or vague notes. Train clinicians on proper anesthesia documentation so there’s no question about time, monitoring, and medical necessity. 

• Submit clean claims. Doublecheck CPT codes, modifiers, and payer-specific requirements before sending claims. A clean claim gets paid faster and avoids rework, which can cost $25–$181 additional per denied claim.  

• Audit routinely. Regular internal audits catch errors before payers do and help ensure compliance with ever-changing rules. They also reveal patterns that can inform future training. 

• Stay current on policies. Keep an eye on insurer bulletins and professional society updates. When you know a payer plans to stop reimbursing certain codes, you can adjust expectations and proactively explain changes to providers. 

  
  

At Essential Anesthesia Management, we pride ourselves on meticulous charting, claim scrubbing, and proactive compliance audits. We can’t control reimbursement policy, but we can make sure our claims tell the full story and stand up to scrutiny. By staying vigilant and adapting to payer changes, we help ensure your hard-earned revenue doesn’t vanish without a fight. 

If you’re interested in our custom anesthesia management solutions, fill out our request a proposal form today.