The state of anesthesia billing

1. Medicare is paying less per unit

Medicare's national anesthesia conversion factor fell from $22.27 in 2019 to $20.31 in 2025, a drop of about 9% before inflation. Every unit a group bills to Medicare is worth less each year, which makes capturing every minute and modifier more important.

Local amounts differ by Medicare locality. Check your contractor's published rates, including for 2026. See the conversion factor explained.

2. A large CRNA workforce

The Bureau of Labor Statistics counted 47,810 employed nurse anesthetists in May 2023, with a mean annual wage of $214,200. The states with the most were Texas (5,390), Florida (3,740), Ohio (3,150), Tennessee (2,950) and Pennsylvania (2,900). Those figures count employees only, so self-employed and 1099 CRNAs are on top.

3. More states let CRNAs practice without physician supervision

27 states have opted out of Medicare's physician supervision rule for CRNAs, most recently Vermont and Ohio in 2026. That opens the door for independent CRNA groups, which need billing, enrollment and contracting help from day one. See the full list.

4. Anesthesia billing is consolidating

Private equity and larger billing companies have been buying anesthesia billing firms for years. A few public examples:

• Ventra Health, backed by Varsity Healthcare Partners, was formed from anesthesia and emergency billing companies.
• Coronis Health, backed by Veritas Capital, combined MiraMed's anesthesia businesses, including Anesthesia Business Consultants, Medac and Plexus.
• Knack RCM bought anesthesia billers Merrick Management (2023) and PPM Partners (2025).
• Cosentus invested in anesthesia-only biller Accreda in September 2025.

For owners of small anesthesia billing companies, that means more interested buyers than ever. For independent groups, it means fewer small, local billers to choose from.

What it means

• For CRNA and anesthesia groups: lower Medicare rates make billing accuracy worth more every year. Track your revenue per unit and net collection rate.
• For billing owners: the market for anesthesia books is active. If you've thought about selling, now is a good time to find out what yours is worth.

Feel free to quote or link to this report with credit to Titrate Revenue.

Sources

• Becker's ASC Review: anesthesia reimbursement decline over the last 5 years
• CMS: Anesthesiologists Center
• BLS: Occupational Employment and Wages, Nurse Anesthetists, May 2023
• Ventra Health
• Becker's Hospital Review: private equity firm combines 2 RCM companies
• PRWeb: Knack RCM announces acquisition of PPM Partners
• Business Wire: Cosentus invests in Accreda