Significant impacts to GI in Medicare Physician Fee Schedule proposed rule

American College of Gastroenterology. American Gastroenterological Association. American Society For Gastrointestinal Endoscopy.

ACG, AGA, and ASGE previously shared an overview of CMS’ proposed payment rules for 2026. There are two specific proposals within the regulation that have significant implications:

  1. A –2.5% efficiency adjustment to the work relative value units (RVUs) for non- time-based services, and
  2. A revision to the practice expense (PE) methodology that would significantly cut payments to physicians for facility-based services, such as those performed in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs).

Together, these policies will cut payments to gastroenterologists for ASC and hospital- based endoscopy and E/M by $58 million, while boosting payments to gastroenterologists who perform office-based endoscopy and E/M by more than $37 million.

For a deeper dive into the proposed rules and their impact on GI providers, read our full summary.

What this means for your practice:

  • ASCs and HOPDs: Practices that provide ASC and hospital outpatient department (HOPD) endoscopy will experience an average 8% cut in physician payments for endoscopy compared to 2025 Medicare rates. Each time you perform a colonoscopy with biopsy (45385), you’ll be paid $14.65 less than 2025. For colonoscopy with snare polypectomy (45385), it will be $18.00 less per procedure. You’ll also see an average 9% cut in E/M payments.
  • Office-based practices: Practices that provide office-based endoscopy will experience an average 16% increase in endoscopy revenue over 2025 Medicare rates. Each time you perform EGD with dilation <30 mm (43249), you’ll be paid $194.01 more than 2025 Medicare rates. You’ll also get an 8% increase in E/M payments.
  • Future payments: We expect more payment cuts in 2027 when one-time payment increases from the One Big Beautiful Bill Act (H.R. 1) expire and physicians experience the full impact of the CMS proposals. Additionally, CMS will cut most physician work payments by 2.5% every three years as part of the “efficiency adjustment.”

Per procedure gains/losses to physician payments for the top GI endoscopy codes

Per procedure gains/losses to physician payment for top GI E/M codes

Overall impact to GI endoscopy and E/M

Overall change in payments to GIs for ASC/HOPD procedures & E/M

+$37,308,922

-$57,985,424


Next Steps

We will be pushing for a more accurate, specialty-specific approach to indirect PE allocation for facility-based care—one that reflects the true resource needs of delivering high-quality GI services in hospital and ASC settings. The CY 2026 PFS Proposed Rule is open for public comment through September 12, 2025.

Take Action: You can help by contacting CMS directly to share your practice-level data and how these policies will impact patient care. Get started using our advocacy tool.

This is crucial to ensure that gastroenterology services are fairly valued and sustainably reimbursed—both now and into the future.

Take Action Now


About Gastrointestinal Endoscopy
Gastrointestinal endoscopic procedures allow the gastroenterologist to visually inspect the upper gastrointestinal tract (esophagus, stomach and duodenum) and the lower bowel (colon and rectum) through an endoscope, a thin, flexible device with a lighted end and a powerful lens system. Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened and active bleeding can be stopped. Polyps in the colon can be removed, which has been shown to prevent colon cancer.

About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with almost 17,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit Asge.org and ValueOfColonoscopy.org for more information and to find a qualified doctor in your area.

 

American Society for Gastrointestinal Endoscopy
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Media Contact

Andrea Lee
Director of Marketing and Communications
630.570.5603
ALee@asge.org