CMS has released its proposed 2026 Medicare Physician Fee Schedule, and it includes several key changes that could significantly impact gastroenterologists.
The American Gastroenterological Association, the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy recently broke down what these updates mean for GI physicians:
1. As part of the “One Big, Beautiful Bill” passed by Congress on July 3, the proposed 2026 conversion factor would increase to $33.42, up from the current $32.35. This represents a $1.07 boost, or a 3.62% increase.
2. Physicians participating in qualifying alternative payment models are set to receive a 3.83% payment increase under the proposed rule.
3. CMS is proposing a new methodology for calculating physician practice expenses, which differentiates more clearly between office-based and facility-based services. This change is expected to particularly impact private practices and leads to varying payment adjustments by care setting:
GI endoscopy
- Office-based payment: +17%
- ASC/Hospital payment: –7%
GI testing
- Office-based payment: +14%
- ASC/Hospital payment: +9%
Evaluation and Management services
- Office-based payment: +8%
- ASC/Hospital payment: –9%
4. CMS proposes a new “efficiency adjustment” of –2.5%, applied to work RVUs and procedure time estimates at the code level. CMS argues this reflects growing provider efficiency over time. These cuts would be reassessed and reapplied every three years.
5. The proposed rule also seeks to permanently allow physicians to provide direct supervision remotely for most procedures, with the exception of those tied to 010- and 090-day global codes.
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