Office-based endoscopy procedures would see an average 16% increase in Medicare payment in 2026, while ASCs and hospital outpatient departments would face an average 8% cut, according to a report from the American College of Gastroenterology.
Here’s a breakdown of which procedures are seeing payment increases by site of care and which are seeing decreases:
What’s up:
- Office-based physician payment for diagnostic colonoscopy (CPT 45378) would increase $50.99, a 16% increase in 2026.
- Office-based physician payment for colonoscopy with biopsy (CPT 45380) would rise $66.91, a 16% increase.
- Office-based physician payment for colonoscopy with lesion removal (CPT 45385) would increase $66.93, a 15% increase.
- Office-based physician payment for esophagogastroduodenoscopy biopsy (CPT 43239) would increase $63.00, an 18% increase.
- Office-based physician payment for esophagogastroduodenoscopy dilation under 30 millimeters (CPT 43249) would increase $194.01, a 20% increase.
What’s down
- Physician payment in ASCs or HOPDs for diagnostic colonoscopy (CPT 45378) would decrease $12.49, a 7% reduction.
- Physician payment in ASCs or HOPDs for colonoscopy with biopsy (CPT 45380) would fall $14.65, an 8% reduction.
- Physician payment in ASCs or HOPDs for colonoscopy with lesion removal (CPT 45385) would decline $18.00, a 7% reduction.
- Physician payment in ASCs or HOPDs for esophagogastroduodenoscopy biopsy (CPT 43239) would drop $8.63, a 7% reduction.
- Physician payment in ASCs or HOPDs for esophagogastroduodenoscopy dilation under 30 millimeters (CPT 43249) would decrease $10.15, a 7% reduction.
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