Surgery centers are finding anesthesia coverage more easily than they have in years. In its third-quarter 2026 survey, released October 16, the Ambulatory Surgery Center Association (ASCA) found that 76% of 307 responding centers across 44 states report adequate access to anesthesia providers. That is the highest share across ASCA's four anesthesia-focused surveys. In 2022 it was 56%.
The relief is uneven. Small centers with one or two rooms report 85% adequate access. Large centers with five or more rooms sit at 70%, and 43% of them offer their anesthesia providers some form of financial assistance. Limited provider availability (81%) and high provider cost (66%) are still the barriers respondents cite most.
For anesthesia groups, the money is where this story turns. Stipends remain the most common form of support. Collections guarantees come second. Flat subsidies are fading fast. As fixed checks give way to arrangements tied to the gap between what a group costs and what it collects, professional fee billing moves to the center of every contract conversation.
Key Takeaways
76% of 307 ASCs in ASCA's Q3 2026 survey report adequate anesthesia access. That is the best result of ASCA's four anesthesia surveys (56% in 2022, 64% in 2023, 70% in 2024).
Large ASCs (five or more rooms) trail at 70%, up from 61% in 2024. Small ASCs (one or two rooms) report 85%.
31% of ASCs offer financial assistance in anesthesia contracts. Among large ASCs, it is 43%.
Stipend contracts (51%) and collections guarantees (29%) are the most common forms of assistance. Flat subsidies fell to 15%, down from 27% in 2023.
Among centers that struggle to keep anesthesia providers, 75% say it affects procedure volume, the same share as in 2024.
What did ASCA's anesthesia survey find?
ASCA runs a short quarterly poll it calls the 60-Second Survey. The third-quarter 2026 edition focused on anesthesia and drew 307 responses from surgery centers in 44 states. ASCA asked similar questions in 2022, 2023 and 2024, so the trend line matters more than any single number.
Access has climbed every time. 56%, then 64%, then 70%, and now 76%. Staffing model makes a visible difference too. Centers that use only anesthesiologists reported 88% adequate access, while centers using CRNAs or anesthesiologist assistants supervised by anesthesiologists reported 72%.
The pain has not gone away for everyone. Among centers that reported difficulty maintaining anesthesia providers, 75% said it affected procedure volume, unchanged from 2024. A case that can't be staffed never produces a facility fee. It never produces an anesthesia claim either.
Why are large ASCs still more exposed?
Large centers have actually improved fastest. ASCA's 2024 survey put their adequate access at 61%. Today it is 70%. Small centers moved from 81% to 85% over the same period.
The gap persists for a simple reason. A five-room center needs far more anesthesia hours every day, and every unstaffed room is idle capacity. Large ASCs are also much more likely to pay for coverage: 43% offer financial assistance in their anesthesia contracts, compared with 31% of all respondents and 23% of centers owned solely by physicians.
Most centers still buy anesthesia from outside groups. 82% use contracted anesthesia services, unchanged from 2024. That rises to 89% among small ASCs and drops to 80% among large ones.
How are ASCs paying to keep anesthesia in the room?
About three in ten ASCs (31%) offer financial assistance to their anesthesia providers. That is essentially flat from 30% in 2024. What has changed is the structure.
Stipend contracts are the most common arrangement at 51%. Collections guarantees follow at 29%. Flat subsidies have dropped steadily, from 27% in 2023 to 21% in 2024 and 15% this year.
A flat subsidy is a fixed payment. A collections guarantee is tied directly to what the anesthesia group brings in. As flat subsidies shrink, more of the money on the table depends on billing performance, and both sides of the contract have a stake in it.
Why does a collections guarantee make billing everyone's problem?
Collections guarantees generally work one way. When the anesthesia group's collections fall below an agreed level, the ASC covers part of the gap. Every denied or underpaid anesthesia claim widens that gap. The center pays for it, and the group's negotiating position weakens with it.
Anesthesia billing has more ways to leak than most specialties. Medicare pays anesthesia on base units plus time units, with each time unit equal to 15 minutes, multiplied by a conversion factor. Start and stop times have to be documented to the minute. Staffing has to be reported with the right modifier: AA when the anesthesiologist personally performs the case, QK or QY when the anesthesiologist medically directs, QX for the medically directed CRNA, and QZ when a CRNA works without medical direction. Under medical direction, the anesthesiologist and the CRNA each receive 50% of the allowance.
ASCA's data shows how mixed staffing has become. 36.2% of respondents use supervised CRNAs or anesthesiologist assistants. 30.9% use CRNAs only. 21.5% use anesthesiologists only. Each model carries its own modifier logic, and a mismatch between the anesthesia record and the claim is one of the easiest denials a payer can issue.
What does a center that has never paid a subsidy do differently?
Becker's ASC Review profiled one on October 16. Casper Surgical Center in Wyoming has gone 26 years without paying an anesthesia subsidy. The same anesthesia group has covered the center since it opened and also covers the local hospital.
The billing is clean and separate. The ASC bills the facility fee and the anesthesia group bills its own professional fees. The center also sends the anesthesia group any schedule changes the day before, so coverage can be planned instead of scrambled.
The center's CEO told Becker's the model may not fix subsidy pressure everywhere, since markets differ. Fair point. The lesson that does travel is narrower. Predictable schedules and a group that collects its own fees well make the economics easier for both sides.
Where do real experts and AI fit in anesthesia revenue cycle?
Anesthesia billing demands two things at once: volume and precision. Every case produces a claim built on time, units, modifiers and payer-specific rules. Cosentus built its model for that exact combination. We call it R+A, Real plus Artificial Intelligence, and it runs on our Zeus AI platform.
Zeus AI agents carry the repetitive work at scale, including eligibility checks, authorizations, claim status and AR follow-up. Named teams of specialty experts own the calls that need judgment, from anesthesia coding and modifier logic to denial strategy and payer negotiation.
For an anesthesia group heading into a stipend or guarantee renewal, that means collections data it can defend. For the ASC, it means a partner whose billing is less likely to trigger a shortfall. An expert behind every AI decision. AI behind every expert.
What This Means for Your Practice
Anesthesia access is improving, and that shifts leverage. When ASCs have more options, the anesthesia group with clean, predictable collections is the one that keeps the contract and negotiates from strength.
Anesthesia groups should start with time documentation and modifier accuracy, checked against the staffing model actually used in each room. Next, track denials and underpayments by payer and by facility so problems show up before the quarterly reconciliation does. And when a stipend or guarantee comes up for renewal, walk in with your own collections data instead of the center's estimate.
ASCs should ask for that same data. If you pay a stipend or back a collections guarantee, your anesthesia group's billing performance is now part of your cost structure.
Frequently Asked Questions
Talk to Cosentus
Cosentus is an AI company with 25+ years of specialty revenue cycle expertise, including anesthesia billing for groups and ASCs. Real experts plus AI on every anesthesia claim, from time units to modifiers to the appeal. See how Zeus AI works at cosentus.com/zeus-ai, or talk to our team at cosentus.com/contact or +1 (877) 266-9040.
Sources
- ASC Focus (ASCA), "ASCA survey shows continued improvement in access to anesthesia services," Oct 16, 2026
- Becker's ASC Review, "Anesthesia crunch eases for ASCs; big centers still squeezed," Oct 16, 2026
- Becker's ASC Review, "The ASC that has never paid an anesthesia subsidy," Oct 16, 2026
- ASC Focus (ASCA), "ASCA Survey Shows Improvement in Access to Anesthesia Services," Nov 15, 2024
- First Coast Service Options (Medicare contractor), "How anesthesia reimbursement is calculated," Aug 25, 2026
- Cosentus Zeus AI, cosentus.com/zeus-ai