On July 7, CMS released its proposed rule updating the 2027 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center payment system, including key changes for gastroenterology leaders.
Here are five takeaways for gastroenterologists and ASC leaders.
1. GI payments would dip even as most top ASC specialties gain. Among the six highest-spending ASC surgical specialty groups, only digestive/gastrointestinal and eye and ocular adnexa procedures are facing projected aggregate payment cuts of 2% and 1%, respectively, in 2027.
By comparison, musculoskeletal and nervous system procedures would see 6% increases. Colonoscopy with lesion removal and colonoscopy with biopsy, the two highest-grossing GI codes among the procedures CMS tracked, at an estimated $273 million and $253 million in 2026 Medicare payments to ASCs, respectively, would each see about a 2% cut. EGD with biopsy, worth an estimated $174 million in 2026 ASC payments, would fall similarly.
2. The ASC conversion factor would rise 2.4%, and CMS is extending a payment policy ASCs have been watching closely. The proposed ASC conversion factor would climb from $56.32 to $57.77 for ASCs meeting quality reporting requirements. CMS is also proposing to extend, for a fifth straight year, use of the hospital market basket (rather than a lower consumer inflation index) to update ASC payments through 2027, a policy the ASC industry has pushed to make permanent.
3. CMS wants to drop the colonoscopy follow-up quality measure. The agency proposed removing the “Appropriate Follow-Up Interval for Normal Colonoscopy in Average Risk Patients” measure from the Hospital Outpatient Quality Reporting and ASC Quality Reporting programs, beginning with the 2027 reporting period. CMS said the measure only tracks whether a 10-year follow-up interval is documented, not whether it’s followed or tied to outcomes. The “Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy” measure would remain in both programs.
4. CMS is seeking input on whether to stratify the ASC Quality Reporting Program’s “All-Cause Transfer/Admission” measure by phase of care, rather than reporting a single rate. In laying out the rationale, CMS specifically named gastroenterology and ophthalmology as the specialties most commonly practiced by single-specialty ASCs treating Medicare patients.
5. More digestive procedures could move off the inpatient-only list. CMS proposed removing 637 more services from the inpatient-only list for 2027 — the second phase of a three-year phaseout — spanning the digestive family along with auditory, endocrine, urinary and other clinical families. CMS is also proposing to add 618 codes to the ASC covered procedures list for 2027. Together, the moves continue a broader shift of procedures toward outpatient and ASC settings.
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.