The push to start routine colorectal cancer screening at age 45 has expanded the eligible pool by millions, and as demand rises, gastroenterologists and facilities are facing growing concerns about reimbursement, capacity and quality benchmarks.
Here are 10 key statistics to know about colonoscopy concerns:
1. Colonoscopy reimbursements have fallen by more than 40% since 2001, even as ASC revenue has grown, shifting the balance of revenue between professional and facility fees, according to a Nov. 21 Medscape report.
2. Between 2018 and 2023, Medicare payments to physicians for GI procedures declined significantly. Inflation-adjusted cuts exceeded 22% for both colonoscopy and esophagogastroduodenoscopy, according to a report in The American Journal of Gastroenterology.
3. Facility-based colorectal cancer screening among young adults has increased since guidelines lowered the recommended screening age to 45, according to a study published in JAMA Network.
4. In 2025, the U.S. Multi-Society Task Force on CRC recommended endoscopists target at least a 90% adequate bowel preparation rate. It also recommended that when prep is inadequate, particularly with alarm symptoms or positive stool-based tests, the exam should be repeated within one year or as soon as possible.
5. A study co-authored by David Johnson, MD, chief of gastroenterology at Eastern Virginia Medical School and Old Dominion University in Norfolk, analyzed 16,747,770 colonoscopies in the GIQuIC registry from 2011 to 2022. Inadequate bowel prep was documented in 920,551 cases, and only 32% of those cases were repeated within a year, as guidelines recommend.
6.Stool DNA testing climbed sharply after the pandemic began, while colonoscopy and fecal immunochemical test use fell, according to a study of nearly 25 million privately insured Blue Cross Blue Shield beneficiaries. Published Oct. 21 in JAMA Network Open, the study found screening patterns shifted after COVID-19’s onset, with the mean bimonthly colonoscopy rate falling from 1.29% from January 2017 to February 2020 to 1.14% from July 2020 to December 2024. Additionally, mean bimonthly FIT rate decreased from 0.54% to 0.38% over the same periods
7. Office-based endoscopy procedures are projected to see an average 16% increase in Medicare payment in 2026, while ASCs and hospital outpatient departments would face an average 8% cut, according to the American College of Gastroenterology.
8. Here’s how physician payment for colonoscopy performed in ASCs or hospital outpatient departments is expected to change:
- Diagnostic colonoscopy (CPT 45378) will decrease $12.49, a 7% reduction.
- Colonoscopy with biopsy (CPT 45380) will fall $14.65, an 8% reduction.
- Colonoscopy with lesion removal (CPT 45385) will decline $18.00, a 7% reduction.
9. Between 2007 and 2022, average GI reimbursement fell 7% unadjusted and 33% when adjusted for inflation, with colonoscopy and biopsy reimbursement dropping 38%, according to a study published in The American Journal of Gastroenterology.
10. Even with the screening age lowered to 45, nearly 40% of eligible adults have not undergone a colonoscopy.
