Anesthesia

Provider Qualifications

Table of Contents

[Return to Top]

General State Licensing

Verify state licensing and specialty certification requirements are current and valid prior to submitting a provider enrollment application to Medicare; ensure all applicable state licensing and/or specialty certification requirements are current. Each state has unique requirements, processes and websites that may vary for individuals and businesses, so each provider will need to follow their individual state’s requirements. For direct links, you may refer to Enrollment > State Licensing and Certification Websites.

[Return to Top]

Physician – Anesthesiologist (Specialty 05)

Physician is defined as a doctor of medicine who is legally authorized to practice in the state in which he/she performs services.

Anesthesiologist generally completes four years of medical school, followed by four years of training in the specialty of anesthesiology – one year of internship and three years in an anesthesiology residency program.

The issuance of a license by a state to practice constitutes legal authorization. If the state licensing law limits the scope of practice of a particular type of medical practitioner, only the services within these limitations are covered.

[Return to Top]

Medical and Surgical Services Performed with Anesthesia by an Anesthesiologist

Anesthesiologists are MDs and are limited only to the scope of practice of MDs.

Payment may be made under the fee schedule for specific medical and surgical services furnished by the anesthesiologist or nonmedically directed CRNAs as long as these services are reasonable and medically necessary and the services are not bundled into other services.

These special services may be furnished in conjunction with anesthesia or as a single service during the day of or the day before the anesthesia service. The services include but are not limited to:

  • Critical care visits
  • Emergency intubation
  • Evaluation of a patient who does not undergo surgery
  • Insertion of CVP lines
  • Insertion of a Swan-Ganz catheter
  • Pain management
  • Preanesthetic examination

Separate payment is not allowed for the anesthesia when a physician performs both the surgery and anesthesia on the same day except for those noted above.

[Return to Top]

Qualified Nonphysician Anesthetists

Payment for the services of a qualified nonphysician anesthetist (AA or CRNA) may be made to the qualified nonphysician anesthetist who furnished the anesthesia services or to a hospital, physician, group practice or ASC with which the qualified nonphysician anesthetist has an employment or contractual relationship.

Note: Fee-for-time compensation do not apply to CRNAs and AAs 

[Return to Top]

Anesthesiologist Assistant (Specialty 32)

An anesthesiology assistant is a person who:

  • is permitted by state law to administer anesthesia,
  • has successfully completed a six-year program for anesthesiologist assistants of which two years consist of specialized academic and clinical training in anesthesia or
  • CRNA

With respect to education and training, CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 140.1 further describes an anesthesiology assistant as academic and clinical training in anesthesia.

[Return to Top]

Certified Registered Nurse Anesthetist (Specialty 43)

A CRNA is a registered nurse who:

  • Is licensed as a registered professional nurse by the State in which the nurse practices
  • Meets any licensure requirements the State imposes with respect to nonphysician anesthetists,

  • Has graduated from a nurse anesthesia educational program that meets the standards of the Council of Accreditation of Nurse Anesthesia Educational Programs

And meets the following criteria:

  • Has passed a certification examination of the Council on Certification of Nurse Anesthetists or the Council on Recertification of Nurse Anesthetists, or
  • Is a graduate of a nurse anesthesia educational program that meets the standards of the Council of Accreditation of Nurse Anesthetists Educational Programs, and within 24 months of graduation has passed a certification examination of the Council on Certification of the Nurse Anesthetists or the Council on Recertification or Nurse Anesthetists.

For more information on CRNAs, refer to:

Revised 10/25/2024