Gastroenterology reimbursement faces new headwinds, with payer and federal policy shifts that could cut pay for gastroenterologists and GI ASCs in 2025 and beyond.
The changes span Medicare, commercial plans and state-level proposals, targeting conversion-factor cuts, site-neutral reform, bundled payments and procedural reimbursements. GI leaders warn these pressures could limit patient access and accelerate the shift of cases into lower-cost settings.
“In 2025, Medicare pays about $220 per colonoscopy, despite added administrative demands,” Benjamin Levy, MD, gastroenterologist at University of Chicago Medicine told Becker’s. “It’s important for physicians to be reimbursed properly to prevent super-experienced gastroenterologists from retiring early.”
Here are five things to know:
1. Medicare conversion factor cut in 2025
CMS finalized a 2.83% cut to the physician fee schedule conversion factor for 2025, bringing it down to $32.35. GI leaders warn it compounds years of downward pressure on colonoscopy and endoscopy reimbursements.
2. GI reimbursement erosion over time
Adjusted for inflation, GI procedure pay dropped by 33% between 2007 and 2022, creating long-term instability for practices. Industry groups say this trend risks shrinking the GI workforce.
“As costs increase and income remains static, there is an inflection point where providers in small practices either take a pay cut as a sacrifice for independence, exit the workforce (such as early retirement or alternate non clinical employment) or join a larger entity,” Surinder Devgun, MD, managing partner of Rochester (N.Y.) Gastroenterology Associates told Becker’s.
3. ASC payment update lags inflation
CMS applied a 2.9% ASC reimbursement increase for centers meeting quality reporting standards, but leaders say costs are rising faster — leaving GI ASCs squeezed even as volumes grow.
4. Rising overhead outpaces GI pay
GI physician compensation rose 33.8% since 2015, but after inflation, real income has declined. In 2025, average GI pay of $495,000 falls short of the $502,930 needed to keep pace with 2015 earnings.
5. Providers adapt to payer disruptions
Leaders say adapting means pursuing value-based contracts and tighter payer alignment.
“ASCs need to choose tighter payer alignment — saying no to low-performing contracts and yes to deeper partnerships that reward value,” Omar Khokhar, MD, gastroenterologist at Illinois GastroHealth in Bloomington told Becker’s.
