Gastroenterologists performing colonoscopies in ASC and hospital outpatient settings are absorbing a targeted physician pay cut in 2026, one that arrives on top of a 40-year erosion in procedure reimbursement and that most high-volume GI programs did not anticipate in their budget planning.
According to the American College of Gastroenterology, ASCs and hospital outpatient departments will experience an average 8% cut in physician payments for endoscopy compared to 2025 Medicare rates. Each time a gastroenterologist performs a colonoscopy with biopsy (CPT 45385), they are paid $14.65 less than in 2025. For colonoscopy with snare polypectomy (CPT 45385), the cut is $18.00 per procedure.
The mechanism behind the cut is a CMS methodology change, not just a conversion factor adjustment. Two CMS policy changes, a 2.5% efficiency adjustment to work RVUs for non-time-based services and a revision to the practice expense methodology, will cut payments to gastroenterologists for ASC and hospital-based endoscopy by $58 million, according to the American Gastroenterological Association. CMS’ rationale, according to the ACG, is that physicians performing procedures in ASC and hospital outpatient settings have lower office overhead costs, and therefore should receive lower practice expense reimbursement.
The cut lands on top of a long downward trajectory. Adjusted for inflation, reimbursement for colonoscopies has already declined 49% since 1992, according to the American Society for Gastrointestinal Endoscopy. Medicare currently pays gastroenterologists approximately $220 for a procedure that takes 30 minutes to an hour, Benjamin Levy, MD, gastroenterologist and clinical associate of medicine at the University of Chicago Medicine, told Becker’s.
Reimbursements for colonoscopies and biopsies decreased 38% from 2007 to 2022, according to a study published in The American Journal of Gastroenterology, before the 2026 cuts took effect.
“Cutting reimbursement doesn’t make patients disappear. When we can’t provide care, those patients end up in emergency rooms with more serious conditions. It’s a short-sighted approach,” Omar Khokhar, MD, a gastroenterologist at OSF St. Joseph Medical Center in Bloomington, Ill., told Becker’s.
The scale of the impact depends on volume. According to the AGA, a practice that performs 900 colonoscopies per year using CPT 45378 could see a $45,891 increase in Medicare payment just for that procedure if it shifts to an office-based setting, the inverse of what ASC-based practices are now absorbing.
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