Hospitals may qualify for a CRNA Exemption that allows anesthesia services provided by Certified Registered Nurse Anesthetists (CRNAs) to be reimbursed under the hospital instead of being billed to Medicare Part B. This exemption is optional and must be renewed every calendar year.

Who Can Qualify?

Your hospital may elect the CRNA exemption under 42 CFR 412.113 if it meets both of the following criteria:

• You performed 800 or fewer surgical procedures during the calendar year.
• Your CRNA(s) worked no more than 2,080 hours at the facility, counting all inpatient and outpatient anesthesia services.

If both apply, you may be eligible to participate for the upcoming year.

How the Election Process Works

Each October, Noridian sends a letter and questionnaire to hospitals that qualified for the CRNA exemption in at least one of the previous two years.

To elect the exemption, simply:

1. Complete the questionnaire (including surgical procedure counts and CRNA hours).
2. Submit annual agreements signed by each CRNA, confirming they will not bill Medicare Part B for services performed at your facility.
3. Return all materials before the deadline.

A CRNA Exemption Request Form is available on our Audit and Reimbursement Forms page for your convenience.

Important Deadline

To ensure your exemption takes effect for the next calendar year, please submit all documents by December 15.

Submitting early ensures smooth processing and uninterrupted exemption status.

Good to Know

• The exemption applies to both inpatient and outpatient anesthesia services.
• The exemption is valid for one calendar year, so you must re‑elect it annually.
• If you exceed the 800‑procedure limit or 2,080‑hour CRNA limit, your exemption cannot be approved for that year and CRNA services must be billed to Part B.