CMS’ final 2027 Medicare payment rules will cut physician payments for GI endoscopy performed in ambulatory surgery centers and hospital outpatient departments by an average of 2%, according to a Nov. 6 alert from The American Gastroenterological Association.
CMS released the final physician fee schedule and outpatient and ASC payment rules Nov. 4. The changes take effect Jan. 1, 2027.
Shakeel Ahmed, MD, a gastroenterologist and founder and CEO of St. Louis-based Atlas Surgical Group, said practices still have to pay nurses, buy supplies and maintain equipment under the lower rates. “Those costs don’t go down when Medicare pays less,” Dr. Ahmed said.
Here are five things to know:
- Physician conversion factors fall. The 2027 conversion factor drops 2.31% to $32.63 for most physicians and 1.83% to $32.95 for those in qualifying advanced alternative payment models. Physician payments for GI endoscopy services performed in ASCs and HOPDs will fall by an average of 2%
- Facility rates rise, but not for GI. CMS finalized a 2.3% overall increase for ASCs and HOPDs that meet quality reporting requirements. Aggregate ASC payments for many GI procedures will still fall 1%.
- New endoscopic submucosal dissection codes pay more. CMS finalized 15 work relative value units for upper GI dissection (CPT 43498) and 16.38 for lower GI dissection (CPT 45991). Both codes move to a higher ambulatory payment classification for complex GI procedures, lifting hospital payment to $7,083.
- Colonoscopy quality measures narrow. CMS removed two GI measures from the Merit-based Incentive Payment System starting in 2027 over the societies’ objections, though a pathology-based follow-up measure remains. The normal-colonoscopy follow-up interval measure will also drop from ASC and hospital outpatient quality reporting programs, a change the societies supported.
- Same-day visit cut lands lighter than proposed. CMS finalized a 20% cut for certain same-day office visits billed with zero-day global procedures, down from a proposed 50% reduction. Gastroenterologists should see little impact because they rarely bill an evaluation and management visit alongside endoscopy.
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