The American Society of Anesthesiologists (ASA) has submitted comments to the Medicare Payment Advisory Commission (MedPAC) on the Commission’s draft recommendation that Congress update physician rates for the CY 2023 Medicare Physician Fee Schedule (MPFS) at the level allowed by statute – 0%. In our letter, we point out how that would in effect, be a negative update as it does not address rising practice costs, inflation, the pandemic and other financial pressures. We provide clear argument to demonstrate that anesthesiologists are uniquely disadvantaged by the Medicare payment system due to the ongoing discrepancy between Medicare and commercial rates for anesthesia services as compared to Medicare and commercial rates for other physician services.