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CMS Opens CRNA Reimbursement Into Pain Management

CRNA Pain Management Services Now Reimbursed If Permitted Under State Law

CMS Pain Managment ReimbursementThe proposed 2013 Medicare Physician Fee Schedule would expand the definition of certified registered nurse anesthetist services to include “medical and surgical services that are related to anesthesia and that a CRNA is legally authorized to perform by the state in which the services are furnished.”  CMS plans to make this change in order to accommodate the laws of several states who are expanding the scope of practice of CRNA’s into areas that are commonly reserved to physicians in the area pain management.

 The new CMS policy would permit CRNAs to be reimbursed for pain management services if those services are within the scope of their practice under the applicable state laws.  The new policy clarifies inconsistent policies among Medicare Administrative Contractors who have been interpreting provisions differently across the country.  CMS cautioned however, that the CRNA is responsible for obtaining appropriate training and education regarding pain management services.

 This area is surfacing as another area of dispute between physician anesthesiologist and CRNA’s.  The American Society of Anesthesiologists has strongly stated its opposition to the CMS rules.  On the other hand the American Nursing Association supports the extension of the law and argue that the accreditation standards for CRNA programs are sufficient to provide CRNA’s with the training necessary to engage in the practice pain management.

 We are likely to see this controversy continue to boil following the finalization of the rule.  The controversy is likely to be taken to the state lawmakers who will be pressured by the Nursing Associations to extend the scope of practice of CRNA’s in individual states.  This may result in a replay of many of the disputes that arose from CMS policies that granted states the ability to grant CRNAs the right to perform anesthesia services without supervision by licensed physicians.

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John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
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