Certified Registered Nurse Anesthetist Pass-Through Exemption

If a critical access hospital (CAH) meets the criteria for pass-through exemption and is interested in selecting the method II option, it can choose method II for all outpatient professionals, except certified registered nurse anesthetist (CRNA), and retain the approved CRNA exemption for both inpatient and outpatient professional services of CRNAs. 

With an approved pass-through exemption, the CAH may choose to give up its exemption for both inpatient and outpatient professional services of CRNAs in order to include its CRNA outpatient professional services with all other professional services under Method II. 

By choosing to include the CRNAs under Method II for outpatient services, the CAH loses its CRNA pass-through exemption for not only the outpatient CRNA services, but also the inpatient CRNA services. In this case, the CAH would have to bill Part B for the CRNA inpatient professional services. All payments for CRNA services are subject to cost settlement. 

If a CAH that meets the criteria for a pass-through exemption is not interested in selecting the Method II option, the CAH can still receive the CRNA pass-through under Method I.

For additional information, please review our article on Election of Cost Reimbursement for CRNA services.

CRNA Accepts Pass-Through Exemption

Method I 

Method II 

CRNA Declines Pass-Through Exemption

Method II 

References

• CMS IOM Pub. 100-04, Claims Processing Manual, Chapter 4, Section 250
• Critical Access Hospitals