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Anesthesia Conditions of Participation – CMS Interpretive Guidelines

 CMS Interpretive Guidelines – Anesthesia Conditions of Participation

On December 11, 2009 CMS released updated Interpretive Guidelines for the Anesthesia Services Condition of Participation (CoP) for Hospitals as an attachment to S&C memo 10-09. Among other things, this guidance was a response to requests for clarification of the distinction between analgesia and anesthesia, given that the regulation at 42 CFR 482.52(a) limits the administration of anesthesia to certain types of practitioners.

The guidance now specifies that hospitals must establish policies and procedures that address whether specific clinical situations involve anesthesia versus analgesia. In addition, hospitals must also specify the qualifications for each category of practitioner who administers analgesia and their supervision requirements. These policies must be based on nationally recognized guidelines. For those procedures that require the administration of anesthesia, the regulations at 42 CFR 482.52(a) concerning who may administer anesthesia continue to apply.  Hospitals that provide Anesthesia Services must also periodically evaluate the effects of their policies regarding the administration of analgesia and anesthesia on the safety of patients and adopt appropriate modifications to these policies as necessary.


With respect to the pre-anesthesia evaluation, the evaluation must be completed within 48 hours prior to surgery or a procedure requiring anesthesia services. However, some individual elements may be performed prior to that period, so long as they are reviewed and appropriately updated within the 48 hour timeframe.

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John H. Fisher

Health Care Counsel
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