Medicare’s 2026 payment rules landed with more bad news for gastroenterologists: another round of cuts to endoscopy payments, a work RVU “efficiency” haircut that specifically targets procedures like colonoscopy, and a widening gap between what GI physicians are paid and what inflation says they’d need to break even.
Here are the numbers driving the conversation.
8%. Medicare’s cut to GI endoscopy payments in ASCs starting Jan. 1, even as the agency raised reimbursement for office-based evaluation and management visits in the same rule.
2.5%. The across-the-board “efficiency adjustment” CMS applied to work RVUs for non-time-based services in the 2026 Medicare Physician Fee Schedule final rule, a cut that lands squarely on procedure-heavy specialties like GI.
$33.57 and $33.40. The 2026 Medicare conversion factors for qualifying and non-qualifying alternative payment model participants, respectively, increases of 3.77% and 3.26% over 2025’s $32.35. The headline increase looks like relief, but GI specialty societies note it doesn’t offset the RVU and site-of-service cuts layered on top.
More than 40%. The decline in colonoscopy reimbursement since 2001, according to a November 2025 Medscape analysis.
22%. The inflation-adjusted drop in physician compensation for colonoscopies between 2018 and 2023, per a study in The American Journal of Gastroenterology. EGDs saw a comparable decline over the same stretch.
33%. The inflation-adjusted erosion in GI reimbursement from 2007 to 2022. Unadjusted, the same figure looks far less alarming, a 7% decline.
$495,000. Average gastroenterologist compensation in 2024, down 3% from $512,000 in 2023. Put in real terms, $370,000 in 2015 would need to be worth roughly $502,930 today just to keep pace with inflation.
37%. The share of gastroenterologists who report feeling fairly paid. Roughly 32% say they’ve taken on additional work to supplement their income.
15%, phasing to zero by 2030. The Medicare coinsurance that still applies the moment a “free” screening colonoscopy turns therapeutic — i.e., the moment a polyp is found and removed. The law phases that coinsurance down to 10% for 2027-2029 and eliminates it in 2030, but until then it applies separately to the physician fee, facility charge, anesthesia and pathology, and can push a patient’s bill toward $3,000. An estimated 35% to 40% of preventive colonoscopies convert to diagnostic or therapeutic billing this way.
32% and 58%. How much more a colonoscopy costs in a hospital outpatient department than in an ASC — 32% more for a screening exam, 58% more for a diagnostic one.
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