Gastroenterologists are raising concerns about the CMS’ finalized payment policies, according to a joint statement from the American College of Gastroenterology, American Gastroenterological Association and American Society for Gastrointestinal Endoscopy.
“We are extremely frustrated that CMS chose to forge ahead on a policy that ACG and other stakeholders conveyed is misguided and not based on any data,” Amy Oxentenko, MD, immediate past president of ACG, told Becker’s. “CMS is choosing speed over quality, which — together with other policies affecting GI services in ASCs and hospital outpatient departments — will significantly impact reimbursement and quality of care.”
Dr. Oxentenko noted that during the recent ACG Annual Scientific Meeting, members discussed research showing that gastroenterologists detect more dysplasia, or precancerous lesions, in inflammatory bowel disease patients with slower colonoscopy withdrawal times, with detection improving by more than 4% for every additional minute.
Here are seven things to know:
1. The conversion factor for practitioners participating in a qualified alternative payment model is $33.56, a 3.77% increase from 2025. Non-QPM practitioners’ conversion factor is $33.4, a 3.26% increase from 2025.
2. Additional adjustments include a 2.5% one-year increase under the One Big Beautiful Bill Act and a 0.49% increase to account for finalized changes in work relative value units.
3. CMS finalized changes to how physician practice expenses are calculated, despite warnings from GI societies about potential harm to high-quality GI care. The change increases payments for office-based services but cuts payments for ASC and hospital outpatient services. It also fails to distinguish between hospital-employed and private-practice physicians.
4. CMS argues that its 2.5% cut to work RVUs for endoscopy and other non-time-based codes is because clinicians become more efficient over time. GI societies argue the policy undermines the congressional CF increases and could devalue services further, as the adjustment will be recalculated every three years with no floor.
5. CMS exempted several procedures with new 2026 CPT codes from the efficiency adjustment, including endoscopic sleeve gastroplasty, periauricular nerve field stimulator placement, and new anorectal manometry and barostat codes replacing 91120 and 91122
6. CMS also finalized its proposal to permanently allow virtual direct supervision for most services requiring supervision. Teaching physicians may also continue virtually supervising residents for telehealth visits in all settings, not just rural areas.
7. As of Tuesday, CMS has not released the final CY 2026 Medicare outpatient facility fees or related policy changes.
