All 10 of the highest-volume ASC procedures would be paid less by Medicare in 2027 under CMS’ proposed outpatient payment rule, according to the Ambulatory Surgery Center Association. Four of those 10 are gastroenterology codes.
The cuts come despite a proposed 2.4% average ASC update. The driver is a proposed cut to the ASC weight scalar, to 0.809 from 0.872, which pulls down relative weights for most common procedures, according to comments from the American Society of Cataract and Refractive Surgery and four other ophthalmology groups.
| Code | Procedure | 2026 final | 2027 proposed | Change |
| 45385 | Colonoscopy with lesion removal by snare | $656.75 | $636.74 | -$20.01 (-3%) |
| 45380 | Colonoscopy with biopsy | $656.75 | $636.74 | -$20.01 (-3%) |
| G0105 | Screening colonoscopy, high-risk patient | $510.49 | $494.01 | -$16.48 (-3.2%) |
| 43239 | Upper GI endoscopy with biopsy | $497.85 | $482.98 | -$14.87 (-3%) |
The GI cuts are the smallest in percentage terms among the top 10. Cataract surgery would fall 3.5%, and lumbar spine injection and nerve ablation codes would drop 3.8% to 4.3%.
ASCA said in its comments that 85 of the top 100 ASC procedures by Medicare volume would be paid less in 2027, largely because of the scalar.
Anesthesia pay would also fall under CMS’ separate proposed physician fee schedule. The proposed 2027 anesthesia conversion factor, $20.2143, down from $20.4976, would trim the national anesthesia payment for a 30-minute diagnostic colonoscopy by about $1.70.
CMS is expected to release the final rule in early November.
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