Office of Inspector General (OIG) Issues Report on Anesthesia Services for Spinal Pain Management

The Office of Inspector General (OIG) released a report on July 31, 2025 on improper Medicare payments for anesthesia services administered during spinal pain management (SPM) procedures. CMS only allows payment for anesthesia services administered during interventional pain procedures, such as facet joint injections, epidural steroid injections and sacroiliac joint injections in rare cases as it is regulated by Local Coverage Determinations (LCDs) and National Correct Coding Initiative (NCCI) edits.  American Society of Anesthesiologists (ASA) has a position statement on proper billing of Anesthetic Care During Interventional Pain Procedures. The position statement outlines the appropriate scenarios to bill for such services. 

ASA is concerned with the OIG’s analysis of the claims data that is based on a small sample that is not representative of a common practice, especially when distinguishing the claims between general anesthesia and moderate sedation.  The study only assessed limited number medical reviews to check if the rare circumstance is documented to justify whether the anesthetic care is reasonable and necessary. The result of the study indicates that there is a lack of proper documentation and Medicare Administrative Contractors (MACs) also are not requesting additional documentation to support the payment. ASA expects to work with the Centers for Medicare and Medicaid Services (CMS) in developing guidance on proper billing and documentation requirements for these procedures to offer additional clarity to all stakeholders.