Bill would raise Medicare surgery-count limit for nurse anesthetist payments

The proposal would raise the surgical-procedure limit from 500 to 1,250 and require HHS to revise the general anesthetist-hours limit to reflect that increase. These limits govern certain Medicare payments based on a hospital's reasonable costs for services by certified registered nurse anesthetists. A hospital with an active labor and delivery unit during a year would be exempt from both the procedure limit and the total anesthetist-hours limit for that year. The procedure-limit changes and revised general hours limit apply to services furnished on or after January 1, 2027.

HHS would adjust any annual payment limit using the prior year's limit and that year's percentage increase in the Medicare Economic Index. The formula covers services paid by Medicare based on reasonable costs under the amended nurse anesthetist payment provision. This formula applies to services furnished on or after January 1, 2027.

HHS would review and update the procedure and anesthetist-hours limits at least once every two years. The review would account for general increases in how often procedures are performed, including increases caused by new procedures. HHS would consult the American Association of Nurse Anesthetists. The Medicare Payment Advisory Commission would report on paying for on-call nurse anesthetist services and possible long-term payment changes. The Medicare Payment Advisory Commission's report would be due within one year after enactment.