Panel of TX Judges Hears Appeal on TMA III

On September 24, 2025, the Fifth Circuit Court of Appeals heard oral arguments in Texas Medical Association (TMA) v. HHS, a case challenging the federal government’s implementation of the No Surprises Act (NSA). Referred to as TMA III, the Texas Medical Association (TMA) contends that the Department of Health and Human Services (HHS) unlawfully calculates the Qualified Payment Amount (QPA) by including “ghost rates”—contracted rates for services never actually performed—which they argue unfairly favor insurers and suppress provider payments. Judges questioned both parties on the statutory meaning of “provided,” the exclusion of value-based payments and bonuses, and the administrative burden of more accurate methodologies.

This case carries significant implications for anesthesiologists, who have been forced out-of-network by payers and who must access the NSA independent dispute resolution (IDR) process to secure appropriate payments.  The American Society of Anesthesiologists (ASA) submitted a joint amicus brief with the American College of Emergency Physicians and the American College of Radiology in support of TMA, emphasizing the need for fair and transparent payment practices that reflect actual services rendered. A ruling in favor of TMA could help restore balance in the independent dispute resolution process and ensure that anesthesiology practices are not disadvantaged under current regulations.