Medicare physician payment reform is ASGE’s top advocacy priority. Current Medicare payments have not kept up with practice cost inflation and are further reduced by frequent budget neutrality adjustments. The budget neutrality threshold of $20 million, established in 1992, has not been updated, leading to payment cuts when exceeded. ASGE calls on policymakers to reform Medicare physician payments to ensure adequacy, fairness, stability, and predictability, while supporting value-based, high-quality care.