Gastroenterology practices are absorbing pressure from two directions at once this year, and physicians and administrators say the damage is showing up procedure by procedure, on individual claims and individual schedules.
CMS’ 2026 Medicare Physician Fee Schedule cut ASC-based GI endoscopy payments by an average of 8% starting Jan. 1, layered on top of a 2.5% reduction to work relative value units for endoscopy and other non-time-based codes. Colonoscopy reimbursement, adjusted for inflation, has fallen more than 40% since 2001, and GI compensation itself slipped from $512,000 in 2023 to $495,000 in 2024.
Carl Dettwiler, MD, a gastroenterologist at Clearwater Gastroenterology in Lewiston, Idaho, told Becker’s that some payers have begun denying claims for a second procedure performed during the same colonoscopy, such as a polypectomy paired with a biopsy.
Dr. Dettwiler’s experience fits a broader pattern GI leaders have flagged for months. Payer policy changes affecting GI claims rose from 67% in 2022 to 77% in 2024, and coding on multiple-procedure colonoscopies, especially the modifiers used when a screening exam converts to a therapeutic one, remains one of the costliest points of failure in GI billing, worth a swing of $218 to $296 in physician reimbursement depending on how it’s coded.
On the operations side, Leslie Hernandez, business manager at Queens Endoscopy ASC, told Becker’s she is fighting the squeeze from a different angle.
“I think overall reimbursement pressure is hitting everyone, especially with the changes impacting GI coding,” she said. “For us, though, one of the bigger challenges has been maintaining procedure volume while so many of our operating costs stay fixed.” Her center is protecting margins by focusing on what it can control: reducing cancellations, tightening scheduling and start-time efficiency, watching supply and labor costs, and staying on top of collections and accounts receivable.
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