Oklahoma Governor Signs ASA/OSA-Endorsed Physical Status Modifier Payment Legislation

Oklahoma Governor Kevin Stitt has signed Senate Bill 1443 into law, enacting a first-of-its-kind anesthesia payment reform that reinforces the importance of patient acuity through the use of physical status (PS) modifiers.

Endorsed by the American Society of Anesthesiologists (ASA) and the Oklahoma Society of Anesthesiologists (OSA), the legislation applies to commercial health benefit plans (excluding Medicaid) and:

1. Requires insurers to consider patient acuity in both coverage determinations and anesthesia payment, including physician-assigned physical status modifiers, case complexity, and urgency of care.
2. Requires payment for physical status modifiers at established base unit values for higher-acuity patients, including:

1. ASA III (P3): +1 unit
2. ASA IV (P4): +2 units
3. ASA V (P5): +3 units

The law responds to troubling actions in 2024, when some insurers announced plans to eliminate additional payments for anesthesia services provided to sicker, more medically complex patients—effectively disregarding the ASA Physical Status Classification System and the heightened clinical expertise, vigilance, and coordination required in these cases.

By restoring appropriate recognition of physical status modifiers, SB 1443 affirms that patients deserve individualized, risk-adjusted care—and that anesthesiologists must be appropriately recognized and paid for safeguarding patient safety and delivering optimal outcomes, particularly in higher-risk settings.

The law takes effect November 1, 2026.