Can CRNAs provide pain management in Texas?

As a landmark 2011 study by the Institute of Medicine (IOM) reported, pain is a serious public health problem, with at least 100 million U.S. adults suffering from chronic pain, at an annual economic cost of up to $635 billion.1 To help address this problem, Certified Registered Nurse Anesthetists (CRNAs) provide acute, chronic, and interventional pain management services.

CRNAs using pain management techniques is neither new nor unusual and has long been a part of CRNA practice.2 In 2012, Medicare published a final rule authorizing direct reimbursement of CRNAs for chronic pain management services. This action confirmed that the federal government recognizes CRNAs as qualified pain management providers.

While few states have attempted to restrict CRNAs from providing pain management services, the Federal Trade Commission has warned that if adopted, legislative or regulatory restrictions on CRNA pain management practice could reduce competition, raise the prices of pain management services, and reduce the availability of these services.3

Occasionally, confusion arises relating to a federal rule that requires supervision of CRNAs as a condition of Medicare reimbursement. This federal rule does not apply to CRNAs when they provide pain management services. In fact, in a letter from the U.S. Department of Health & Human Services to GAO on this issue, the agency expressly states, “The supervision rule does not apply to non-anesthesia services furnished in hospital or ASCS nor to any service furnished outside of those settings, such as services furnished in the home or in a physician’s office.”


Pain Management from CRNAs in the State of Texas

HHSC Letter 1.24.2014 - Pain Management



1 Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research (Institute of Medicine, Committee on Advancing Pain Research, Care, and Education)(2011, National Academy of Sciences, prepublication copy)
2 AANA, Scope of Nurse Anesthesia Practice, at \
3 FTC March 27, 2012 letter to Missouri Representative Jeanne Kirkton at, and FTC April 19, 2013 letter to Illinois Senator Heather Steans at