CMS ruling codifies authority for nurse anesthetists

The American Association of Nurse Anesthetists applauded the Centers for Medicare & Medicaid Services’ final ruling on Medicare coverage of chronic pain management services provided by certified registered nurse anesthetists.

The rule takes effect Jan. 1 and expands Medicare coverage of services within CRNAs’ scope of practice. “Anesthesia and related care means those services that a certified registered nurse anesthetist is legally authorized to perform in that state in which the services are furnished,” according to the rule.

In issuing its ruling, CMS largely agreed with the AANA and others who submitted comments through the Protect My Pain Care Campaign, which advocated for states to have primary responsibility for establishing the scope of services that CRNAs are trained for and authorized to provide. The rule defines the Medicare benefit category for CRNAs as including any services CRNAs are permitted to furnish under their state’s scope of practice.

The rule “means that under Medicare, Americans suffering from chronic pain will continue to receive the pain care they need from CRNAs they know and trust,” the AANA stated.

“This ruling is an important development both for patients and for the nation’s 45,000 nurse anesthetists who deliver more than 33 million anesthetics every year and have gone through nationally accredited educational programs at the master’s or doctoral level. It is consistent with the Institute of Medicine’s recommendation that Medicare cover services provided by advanced practice nurses to the full extent of their state’s scope of practice.

“It is especially meaningful for patients in rural and other medically underserved communities. Without local access to pain treatment from CRNAs, many seniors would have to travel long distances to receive care, move into a nursing home or forgo treatment altogether. This federal ruling also respects state scope of practice rules and regulations.”

A PDF of the newly issued CMS regulations is available at

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