C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER G—STANDARDS AND CERTIFICATION › PART 482—CONDITIONS OF PARTICIPATION FOR HOSPITALS › Subpart D—Optional Hospital Services

42 C.F.R. § 482.52

Condition of participation: Anesthesia services

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If the hospital furnishes anesthesia services, they must be provided in a well-organized manner under the direction of a qualified doctor of medicine or osteopathy. The service is responsible for all anesthesia administered in the hospital.

(a) Standard: Organization and staffing. The organization of anesthesia services must be appropriate to the scope of the services offered. Anesthesia must be administered only by—

(1) A qualified anesthesiologist;

(2) A doctor of medicine or osteopathy (other than an anesthesiologist);

(3) A dentist, oral surgeon, or podiatrist who is qualified to administer anesthesia under State law;

(4) A certified registered nurse anesthetist (CRNA), as defined in § 410.69(b) of this chapter, who, unless exempted in accordance with paragraph (c)of this section, is under the supervision of the operating practitioner or of an anesthesiologist who is immediately available if needed; or

(5) An anesthesiologist's assistant, as defined in § 410.69(b) of this chapter, who is under the supervision of an anesthesiologist who is immediately available if needed.

(b) Standard: Delivery of services. Anesthesia services must be consistent with needs and resources. Policies on anesthesia procedures must include the delineation of preanesthesia and post anesthesia responsibilities. The policies must ensure that the following are provided for each patient:

(1) A preanesthesia evaluation completed and documented by an individual qualified to administer anesthesia, as specified in paragraph (a) of this section, performed within 48 hours prior to surgery or a procedure requiring anesthesia services.

(2) An intraoperative anesthesia record.

(3) A postanesthesia evaluation completed and documented by an individual qualified to administer anesthesia, as specified in paragraph (a) of this section, no later than 48 hours after surgery or a procedure requiring anesthesia services. The postanesthesia evaluation for anesthesia recovery must be completed in accordance with State law and with hospital policies and procedures that have been approved by the medical staff and that reflect current standards of anesthesia care.

(c) Standard: State exemption. (1) A hospital may be exempted from the requirement for physician supervision of CRNAs as described in paragraph (a)(4) of this section, if the State in which the hospital is located submits a letter to CMS signed by the Governor, following consultation with the State's Boards of Medicine and Nursing, requesting exemption from physician supervision of CRNAs. The letter from the Governor must attest that he or she has consulted with State Boards of Medicine and Nursing about issues related to access to and the quality of anesthesia services in the State and has concluded that it is in the best interests of the State's citizens to opt-out of the current physician supervision requirement, and that the opt-out is consistent with State law.

(2) The request for exemption and recognition of State laws, and the withdrawal of the request may be submitted at any time, and are effective upon submission.

[51 FR 22042, June 17, 1986, as amended at 57 FR 33900, July 31, 1992; 66 FR 56769, Nov. 13, 2001; 71 FR 68694, Nov. 27, 2006; 72 FR 66934, Nov. 27, 2007]
Notes of Decisions
Cited in 10 cases (2 in the last 5 years), 2007–2024 · leading case: California Soc'y of Anesthesiologists v. Brown, 204 Cal. App. 4th 390 (Cal. Ct. App. 2012).
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California Soc'y of Anesthesiologists v. Brown, 204 Cal. App. 4th 390 (Cal. Ct. App. 2012). · cites it 6× “( 42 C.F.R. §§ 482.52 (a)(4) (2011), 416.42(b)(2) (2011), 485.”
Colorado Med. Soc'y v. Hickenlooper, Colorado Governor, 2015 CO 41 (Colo. 2015). · cites it 3× “42 CFR. §§ 482.52 (hospitals), 485.639 (critical access hospitals), 416.”
Colorado Med. Soc'y v. Hickenlooper, 353 P.3d 396 (Colo. Ct. App. 2012). “42 (ambulatory surgical center) 42 C.F.R. § 482.52 (hospital); 42 C.F.R. § 485.”
Question Submitted by: Rep. Marcus McEntire, Oklahoma House of Representatives, Dist. 50, 2024 OK AG 14 (Okla. Att’y Gen. 2024). · cites it 10× “¶5 In contrast, the relevant federal regulation, 42 C.F.R. § 482.52, imposes a condition precedent on hospitals participating in Medicare and receiving federal reimbursement for providing anesthesia services.”
Montana Soc'y of Anesthesiologists v. Montana Bd. of Nursing, 2007 MT 290 (Mont. 2007). “42 CFR § 482.52 . ¶8 On September 6, 2002, Montana Governor Judy Martz requested that the BON and the Board of Medical Examiners (the BME) study the matter.”
Ida Hawkins, Charlotte Hawkins, & Christopher Hawkins Individually & in their Rep. Capacities of the Minor Child., S.L., E.L., C.H., & C.H. v. The Schumacher Grp. of Louisiana, Inc., Clinical Partners-Louisiana, PLLC, Andre Leblanc Med. Consultants, LLC, Morehouse Par. Hosp. Serv. Dist. d/b/a Morehouse Gen. Hosp., Andre Michel Leblanc, CRNA, Dr. Daniel Umoh, Dr. Janos Guoth, Linda Richard, CRT, Bridget Humphrey Major, LPN, Fleta Stell, RN, Adam Clampit, RN, & Teresa Hankins, RN (La. Ct. App. 2019). · cites it 6× “(2) COMPLIANCE WITH 42 CFR § 482.52 . [Clinical Partners] agrees that it will provide anesthesia services in a well organized manner under the sponsorship of a qualified doctor of medicine or osteopathy and will otherwise insure that such services are rendered in compliance with…”
Khoury v. Intermountain Health Care Inc. (D. Utah 2022). · cites it 3× “42 C.F.R. § 482.52 (b). This record details anesthesia-related events during surgery.”
United Auburn Indian Cmty. of the Auburn Rancheria v. Newsom (Cal. 2020). “exercised his discretion under federal law [ 42 C.F.R. § 482.52 (c)(1) (2020)] [to opt] California out of the federal physician supervision Medicare reimbursement requirement”]; Fort Ord Reuse Authority, Media Release: Major Event in Completion of Early Transfer of Former Fort…”
Anesthesiologists v. Bd. of Nursi, 2007 MT 290 (Mont. 2007). “42 CFR § 482.52 . ¶8 On September 6, 2002, Montana Governor Judy Martz requested that the BON and the Board of Medical Examiners (the BME) study the matter.”
Anesthesiologists v. Bd. of Nursi, 2007 MT 290 (Mont. 2007). “42 CFR § 482.52 . ¶8 On September 6, 2002, Montana Governor Judy Martz requested that the BON and the Board of Medical Examiners (the BME) study the matter.”
— 42 C.F.R. § 482.52(c) — 1 case
Question Submitted by: Rep. Marcus McEntire, Oklahoma House of Representatives, Dist. 50, 2024 OK AG 14 (Okla. Att’y Gen. 2024). “¶5 In contrast, the relevant federal regulation, 42 C.F.R. § 482.52, imposes a condition precedent on hospitals participating in Medicare and receiving federal reimbursement for providing anesthesia services.”
— 42 C.F.R. § 482.52(c)(1) — 1 case
Question Submitted by: Rep. Marcus McEntire, Oklahoma House of Representatives, Dist. 50, 2024 OK AG 14 (Okla. Att’y Gen. 2024). “¶5 In contrast, the relevant federal regulation, 42 C.F.R. § 482.52, imposes a condition precedent on hospitals participating in Medicare and receiving federal reimbursement for providing anesthesia services.”
— 42 C.F.R. § 482.52(c)(1l) — 1 case
Colorado Med. Soc'y v. Hickenlooper, Colorado Governor, 2015 CO 41 (Colo. 2015). “42 CFR. §§ 482.52 (hospitals), 485.639 (critical access hospitals), 416.”
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