Anesthesia Billing Services: Why Most Anesthesia Practices Are Getting Paid Less Than They Should

By Medtransic Editorial Team | February 17, 2026 | 12 min read

Quick Summary: Anesthesia practices routinely lose 8–14% of collectible revenue to billing errors that never show up on a denial report. Here's what's happening on every case — and what it's costing you.

Most anesthesiologists assume that if claims are going out and payments are coming in, billing is working. It's not a bad assumption — until you realize that anesthesia billing has more ways to silently underpay you than almost any other specialty in medicine. Not denials. Not obvious errors. Just quiet, systematic underpayment on cases you already worked, patients you already treated, and money you already earned. Practices that switch to a specialist anesthesia billing service typically recover 8–14% in revenue they didn't know they were missing.

The Silent Revenue Problem in Anesthesia

Anesthesia is billed completely differently from every other specialty. Your cardiologist colleague gets paid a flat fee per procedure. You get paid based on a formula: the complexity of the case, how long you were in the room, and whether special circumstances applied. Every one of those variables is a potential revenue leak — and unlike a denied claim, underpayment never triggers an alert. The money just doesn't show up, and nobody flags it.

The practices that lose the most are usually the ones using a general medical billing service that handles anesthesia on the side. Anesthesia billing requires specialty knowledge that most general billers don't have. When they get something wrong, they don't get a denial — they get paid less. And you never know the difference because you don't know what the number should have been.

The Time Unit Problem Nobody Talks About

Here's a specific example of how money disappears. Anesthesia reimbursement is partly based on how long you were with the patient. Medicare calculates that time in 10-minute blocks. Most private insurers use 15-minute blocks. If your billing company uses the wrong increment for the wrong payer — which happens constantly when billers aren't anesthesia specialists — you're either getting paid for less time than you worked, or overbilling and creating audit risk. Either way, you lose.

On a single complex spine case that runs 3 hours, getting the time increment wrong can mean $60–$90 in lost reimbursement. That sounds small until you multiply it across your case volume. A group doing 200 cases a month with systematic time calculation errors is losing $12,000–$18,000 before a single claim is even reviewed. It shows up as a gradual reduction in collections that gets blamed on payer mix or case complexity — not on a billing error that's been running quietly for months.

You're Leaving Money on the Table With Every Elderly Patient

When you provide anesthesia to a patient over 70, Medicare and most insurers recognize that this is higher-risk, higher-effort work and pay more for it. There's a specific add-on code — think of it as a bonus line item — that adds extra reimbursement to the claim. Same thing applies for emergency cases and a handful of other documented situations. These aren't gray areas. They're legitimate, documented, and fully billable.

Most general billing companies never add them. They process the base claim, the time, and move on. The bonus code requires the biller to look at the patient record, confirm the age or circumstance, and add the extra line. It's a 30-second step that pays $43–$107 extra per eligible case. At a Medicare conversion rate, a group doing 50 eligible cases a month and missing this code consistently is leaving $2,150–$5,350 on the table every single month. That's $25,000–$64,000 a year from one overlooked step.

Your CRNA Setup Could Be a Compliance Risk You Don't Know About

If you work with CRNAs — nurse anesthetists — the way their work is billed depends on how involved you are in each case. Are you personally in the room? Supervising from outside? Directing four rooms at once? Each situation has a different billing code, and using the wrong one isn't just a revenue problem. It's a compliance problem that can trigger audits and recoupment demands going back years.

The most common error in group practices is what happens when a physician is supervising multiple CRNAs simultaneously. In that setup, both the physician and the CRNA need to file their own claims — and the two claims have to match. If the physician files their code without the corresponding CRNA code, or vice versa, both claims get denied or flagged. This happens constantly in practices where billing isn't anesthesia-specific, because the biller doesn't know to track the pair. The credentialing team at Medtransic verifies supervision arrangements for every provider before a single claim goes out.

For practices in states that allow CRNAs to work independently — California, Colorado, Oregon, and more than a dozen others — there's an additional layer of complexity. The rules that apply to your state don't necessarily apply to every insurer in your state. Each commercial payer has its own contract terms. A CRNA billing independently to a payer that requires physician supervision will get the claim denied and possibly trigger a fraud review. This is a contract management issue as much as a billing issue — and it's exactly the kind of thing that falls through the cracks at a general billing company.

What Good Anesthesia Billing Actually Looks Like

Good anesthesia billing is invisible to you. Cases go out, payments come in, your collections are where they should be, and you're not spending mental energy wondering whether your billing company knows what they're doing. That's the goal — not a billing education, not a compliance workshop, not a monthly denial report to wade through. Just accurate, complete claims that get paid at the right amount, on time.

What makes that possible is having someone who reviews every case before it's billed — not just checking that a code exists, but verifying that the right code was used for the right payer, that every eligible add-on was captured, that the physician and CRNA claims match if both were involved, and that the time documentation supports every unit billed. That's the standard Medtransic holds for every anesthesia case. Our team integrates directly with your existing system — Epic, AdvancedMD, eClinicalWorks — so there's no workflow disruption and no data re-entry.

• <3% Denial Rate - vs. 8–12% industry average
• <28 days Time to Payment - Average days in AR
• 8–14% Revenue Recovery - What new clients typically find in their first audit

The Denials Quietly Killing Your Cash Flow

Beyond the underpayment problem, there are denials — and anesthesia has its own specific ones that differ from every other specialty. The most common: billing the surgical procedure code instead of the anesthesia code. To a general biller, a knee replacement is a knee replacement. To an anesthesia biller, it's a completely different code that lives in a completely different section of the billing system. Submit the wrong one and the claim auto-denies. It's a fixable error, but it adds 30–60 days to your payment cycle and ties up staff time on resubmissions.

• Wrong procedure code: The surgical code gets submitted instead of the anesthesia-specific code. Auto-denial. Happens when billers aren't trained specifically in anesthesia.
• Missing time documentation: If the anesthesia record doesn't show a clear start and stop time, Medicare will deny or reduce the claim. The fix has to happen before billing, not after denial.
• No Surprises Act compliance gaps: Since 2022, if you're out-of-network at an in-network facility, you can't balance bill the patient — but you can dispute a low payer payment through a formal process. Most practices don't know this process exists, let alone use it. Missing the filing window means accepting whatever the insurer offered.
• Post-surgery pain management unbilled: If you placed an epidural catheter for pain management after a chest surgery, that's separately billable from the anesthesia itself. It's routinely missed — not because it's controversial, but because it requires someone to be looking for it.

The denial management team at Medtransic handles every resubmission, appeal, and No Surprises Act dispute filing — so your front office isn't spending time on billing follow-up and your revenue isn't sitting in a denial queue for months. For practices dealing with aging accounts receivable, we also run retroactive audits to recover what's been underpaid or denied in prior claim cycles.

How Medtransic Helps Anesthesia Practices Collect More

Medtransic specializes in medical billing for complex specialties — the ones where a general billing company's gaps cost practices real money. Anesthesia is at the top of that list. Our billing team reviews every case for every variable that affects your reimbursement: the right code for the right payer, every eligible add-on, matched physician and CRNA claims, verified time documentation, and payer-specific contract terms. Before the claim goes out, not after it comes back denied.

For new anesthesia clients, we start with a complimentary audit of 90 days of claims. In most cases, that audit surfaces thousands of dollars in recoverable revenue from underpaid or incorrectly billed cases. We show you exactly what was missed, what it's worth, and how we would have billed it differently. Then it's your call. Similar billing complexity exists in other surgical specialties — if your practice also covers pain management or orthopedic cases, those carry their own revenue leak patterns worth examining.

We also handle everything upstream and downstream: insurance verification before each case so there are no eligibility surprises, credentialing for both physician and CRNA providers across all payers, and prior authorization management so scheduled cases don't hit a wall at the last minute. The goal is a billing operation that runs completely in the background while you run your practice.