A growing disconnect between innovation and reimbursement could become one of gastroenterology’s most consequential disruptors in 2026, Tyler Berzin, MD, associate professor of medicine at Harvard Medical School and a gastroenterologist at Beth Israel Deaconess Medical Center, both based in Boston, told Becker’s.
“I would argue that a ‘negative disruptor’ in gastroenterology in 2026 will be the growing penalty for innovation and complexity,” Dr. Berzin told Becker’s. “Advanced endoscopic procedures and their supporting technologies require significant expertise and infrastructure that current reimbursement models still fail to recognize. As a result, innovation is constrained not by what is technically possible, but by what the system is willing to value.”
His warning comes as GI practices and endoscopy centers face intensifying financial pressure from Medicare and commercial reimbursement erosion, rising labor costs and policy headwinds that can make it harder to justify investment in high-skill, higher-resource procedures.
Adding to that strain, Medicare on Jan. 1 reduced payments for GI endoscopy services performed in ASCs by an average of 8% while increasing reimbursement for office-based E/M visits.
Dr. Berzin pointed to endoscopic submucosal dissection as an example. In the right patients, the procedure can help avoid major surgery, but “legacy payment structures have discouraged hospitals from investing in it at scale,” he said.
While there is now “some light on the horizon” with CPT codes established after years of delays, he said many other high-value procedures still lack reimbursement that reflects their complexity. Beyond payment, ESD also requires longer procedure times, advanced devices, specialized training and coordinated anesthesia and nursing support — factors that raise costs compared with standard endoscopic resections.
In May 2025, the American Medical Association’s CPT Editorial Panel agreed to establish two Category I CPT codes for endoscopic submucosal dissection, one for the upper GI tract and one for the lower GI tract. Final code numbers, descriptors and fee schedules are expected to be published in November 2026, with the codes anticipated to take effect Jan. 1.
According to a May 26 news release from the Olympus Corporation of the Americas, a medtech company, the dedicated CPT codes are expected to support wider adoption of ESD by creating a standardized reimbursement pathway and reducing barriers to provider investment and patient access. Still, the years-long gap between clinical validation and payment recognition underscores the financial friction advanced endoscopy faces.
More broadly, Dr. Berzin’s view that the healthcare system under-recognizes complexity is showing up across GI practice economics. Gastroenterology billing is inherently complex and increasingly demands a strategic approach, as industry leaders have said the specialty is disproportionately affected by pay cuts and restrictive payer practices.
Between 2018 and 2023, inflation-adjusted Medicare payments to physicians for colonoscopies declined by more than 22%, according to The American Journal of Gastroenterology.
Even procedures with clear clinical benefit can struggle for adequate payment, and GI leaders have warned that reimbursement often fails to reflect complexity or innovation.
“A real challenge we are facing is the inability to get reimbursed for a host of relatively newer (but well-established) endoscopic procedures that have emerged in the last decade or so,” Vivek Kaul, MD, professor of medicine in the gastroenterology and hepatology division at the University of Rochester (N.Y.) Medical Center, told Becker’s. “Oftentimes, these are minimally invasive, transformational interventions for our patients that help reduce morbidity, length of stay and overall healthcare costs but are poorly reimbursed or not reimbursed at all, in some cases.”
Dr. Berzin also warned that a similar dynamic could emerge as AI advances beyond polyp detection and into clinical decision-making.
“A similar pattern may emerge in the AI space with tools that extend beyond polyp detection toward AI-supported diagnosis and decision-making,” he said. “Because these tools do not align with existing billing categories, their clinical value may remain largely invisible to the system.”
