Colonoscopy accounts for 13.4% of all ASC procedure volume nationally, making it one of the most consequential lines in an ASC’s Medicare revenue.
CMS’ proposed 2027 payment rules would trim what Medicare pays for the procedure on both the facility and the physician side, even as a scheduled change lowers what patients owe when a screening turns into polyp removal.
Here are five numbers to know:
1. $636.74: The proposed 2027 national ASC rate for both colonoscopy with biopsy (CPT 45380) and colonoscopy with lesion removal by snare (CPT 45385), down from $656.75 in 2026. The $20.01 reduction amounts to about a 3% cut for each code. The rate for high-risk screening colonoscopy (G0105) would fall 3.2%, from $510.49 to $494.01.
The cuts would come even though the ASC conversion factor would rise 2.4%, from $56.32 to $57.77, for centers meeting quality reporting requirements. All 10 of the highest-volume ASC procedures, including three colonoscopy codes, would be paid less by Medicare in 2027 under the proposal.
2. $526 million: Medicare paid an estimated $273 million for colonoscopy with lesion removal and $253 million for colonoscopy with biopsy in ASCs in 2026, according to CMS estimates. Digestive and gastrointestinal procedures face a projected 2% aggregate payment cut in 2027, while musculoskeletal and nervous system procedures would see 6% increases.
3. 3%: Physician payments for GI endoscopy in ASCs and HOPDs would fall about 3% under the proposed 2027 physician fee schedule, according to the American Society for Gastrointestinal Endoscopy. Most of the drop stems from the expiration of a one-time 2.5% increase Congress approved for 2026. The conversion factor for clinicians who are not qualifying alternative payment model participants would fall 1.68%, from $33.4009 to $32.8409.
The proposed cut would land on top of the 2026 rule, which reduced Medicare physician payments for ASC- and hospital-based endoscopy by an average of 8% while office-based procedures rose 16%.
4. 50%: CMS has also proposed a same-day payment policy aimed at proceduralists. When a physician performs a procedure and bills a separate office visit for the same patient on the same day, CMS would pay the most expensive service in full and cut the others to 50%.
5. 10%: On the patient side, Medicare coinsurance for a planned screening colonoscopy that includes polyp removal will drop from 15% to 10% on Jan. 1 and stay there through 2029, under a phase-down CMS finalized in 2021. Coinsurance is scheduled to reach zero in 2030.
The change matters because conversions are common. Roughly 35% to 40% of preventive colonoscopies convert to diagnostic or therapeutic procedures mid-case.
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