A 1099 CRNA is an independent contractor who is paid by a facility or group without being their employee. You usually earn a higher rate, but you take on your own taxes, benefits, insurance and business paperwork.
Whether it suits you depends on your experience, your appetite for admin, and how stable your contracts are. This guide covers the main points to understand before you switch.
W-2 vs 1099 at a glance
| W-2 employee | 1099 contractor | |
|---|---|---|
| Pay | Salary or hourly | Usually a higher hourly or daily rate |
| Taxes | Withheld by employer | You pay estimated taxes yourself |
| Benefits | Health, retirement, PTO often included | You fund your own |
| Malpractice | Usually provided | Often your responsibility; check the contract |
| Schedule | Set by employer | Negotiated per contract |
| Admin | Minimal | Bookkeeping, contracts, credentialing |
Pros of 1099 work
- Higher rates. Contract rates are usually higher per hour, since the facility is not paying benefits.
- Control. You choose your contracts, hours and time off.
- Business options. You can set up your own entity and retirement plan, with advice from a tax professional.
- Variety. You can work across several facilities.
Cons of 1099 work
- No paid time off. If you do not work, you do not get paid.
- Uneven income. Cancelled cases and lost contracts hit you directly.
- More responsibility. You handle taxes, insurance, licensing and credentialing.
- Less support. New graduates usually benefit from a W-2 job first.
Taxes
As a contractor, nobody withholds tax from your pay. You generally pay estimated taxes during the year, plus self-employment tax that covers both sides of Social Security and Medicare.
Many 1099 CRNAs form an LLC or S corporation and track business expenses. The right setup depends on your income and state. Work with a CPA who knows health care contractors. AANA also runs the 1099 CRNA Institute, a paid course on taxes, entity choice and running your business.
This page is general information, not tax, legal or billing advice.
Malpractice insurance
Read who provides malpractice cover. Some contracts include it; many expect you to bring your own.
Ask about:
- The policy limits the facility requires
- Whether the policy is occurrence or claims-made
- Who pays for tail coverage when a claims-made policy ends
Billing: who bills for your work, and why it matters
This is the part many contractors skip. When you give anesthesia, someone sends a claim to Medicare, Medicaid or a private insurer. There are two common setups.
The facility or group bills
You are paid an agreed rate. The facility or group bills payers for your services. For Medicare, this is usually done through a reassignment of benefits, which lets the group receive payment for services billed under your provider number.
This is simpler for you. But claims still go out under your National Provider Identifier (NPI), so you should know how your work is documented and coded. Errors billed under your number can affect you.
You (or your own group) bill
You enroll with payers and bill them directly, or hire a billing company to do it. Payments come to you. This can increase what you collect, but you take on enrollment, coding, follow-up and compliance work.
Why it matters
Billing affects your income and your negotiating power. If a facility bills for your services, the amount it collects is part of the value you bring. Knowing roughly what is collected helps you set a fair rate. Ask these questions before you sign:
- Who will bill for my services, and under which NPI?
- Will I need to sign a reassignment of benefits?
- Can I see how my cases are coded?
- Does my pay depend on the facility being paid first?
Contract terms to check
- Rate: hourly, daily or per case, with any minimum guarantee
- Cancellations: what you are paid if cases are cancelled or the day ends early
- Call and overtime: how they are paid
- Payment terms: when you are paid and how disputes are handled
- Malpractice and indemnity: who carries which insurance and who is responsible if something goes wrong
- Term and notice: how either side can end the contract
- Non-compete: limits on working at nearby facilities; rules vary by state
Have a health care lawyer review any contract before you sign.
Is 1099 right for you?
It often suits experienced CRNAs who want control over their schedule and are comfortable with business admin. It suits fewer new graduates, who usually benefit from the structure and support of a W-2 role.
If you are weighing offers, see CRNA starting salary, the best CRNA jobs and CRNA salary by state.
FAQ
Do 1099 CRNAs earn more?
Rates are usually higher, but you pay for benefits, insurance and both sides of payroll taxes. Compare offers on take-home value after those costs.
Can a new graduate work 1099?
Some do, but many contract roles prefer experienced CRNAs. Most new graduates start in a W-2 job.
Do I need my own billing?
Only if you bill payers yourself. If the facility bills, you still benefit from understanding what is billed under your NPI.
For more on billing, read a plain-English guide to billing for 1099 CRNAs.
Sources
- AANA: 1099 CRNA Institute
- AANA: Employment resources
- BLS Occupational Employment and Wage Statistics (May 2025)
Disclosure: Nelson is a founding adviser to Titrate Revenue, a US anesthesia billing company.