GI procedure demand keeps climbing while Medicare keeps cutting what it pays for the exact setting where those procedures are cheapest to perform.
Here are nine numbers to know:
28.3%: GI procedures’ share of Medicare/Medicaid ASC volume nationally; colonoscopy alone accounts for 13.4% of all ASC procedure volume.
19%: Increase in GI case volume per center from 2023 to 2024 (349 to 416 cases), per HST Pathway benchmarking data.
8%: Average cut to Medicare physician payments for ASC- and hospital-based endoscopy starting Jan. 1, versus a 16% increase for the same procedures performed in-office.
$58 million: Total Medicare payment reduction for ASC/hospital-based endoscopy under the 2026 rule; office-based endoscopy gained $37 million.
$14.65 and $18: Per-procedure cuts to colonoscopy with biopsy (CPT 45380) and colonoscopy with snare polypectomy (CPT 45385), respectively.
22%: Inflation-adjusted decline in Medicare colonoscopy payments to physicians from 2018-2023 alone; the decline reaches 38% going back to 2007.
$1,136 vs. $1,608: Average colonoscopy cost at an ASC versus a hospital outpatient department; screenings run 32% more expensive in hospitals, diagnostic procedures 58% more.
$45,891: Additional annual Medicare payment a practice performing 900 colonoscopies (CPT 45378) could collect by shifting from ASC to office-based billing.
35%-40%: Share of screening colonoscopies that convert mid-procedure to therapeutic (billable at a higher rate under Modifier PT). which is a coding distinction that ASCs get wrong often enough to trigger denials when PT and Modifier 33 are mixed up.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
