CMS’ final 2027 outpatient and ASC payment rule gives centers a 2.3% update, and GI leaders said many endoscopy procedures will still see Medicare pay fall.
CMS finalized the rule Nov. 4. The 2.3% update applies to centers that meet quality reporting requirements; centers that don’t get 0.3%. The rule also cut the ASC weight scalar to 0.814 from 0.872. That turns the update into a pay cut for many high-volume procedures, including GI, ophthalmology and pain management cases.
CMS projects 2027 Medicare payments for GI procedures in ASCs will fall 1%. The cut applies to the specialty’s biggest codes:
- Colonoscopy with lesion removal (CPT 45385): about $273 million in estimated 2026 Medicare ASC payments, down 1%.
- Colonoscopy with biopsy (CPT 45380): about $253 million, down 1%.
- Upper endoscopy with biopsy (CPT 43239): about $174 million, down 1%.
The rule also adds 619 procedures to the ASC covered procedures list, mostly outside GI.
Gastrointestinal procedures account for 28.3% of all Medicare ASC volume, making GI the dominant service line in the ASC space, according to a MedPAC report. Eight GI-related procedures, including colonoscopy with lesion removal, upper GI endoscopy with biopsy, and colonoscopy with biopsy, collectively account for that share.
CMS’ final 2027 Medicare payment rules will cut physician payments for GI endoscopy performed in ASCs and hospital outpatient departments by an average of 2%, according to a Nov. 6 alert from The American Gastroenterological Association.
“These procedures are the backbone of colorectal cancer screening and early detection, and ASCs deliver them at a fraction of hospital costs,” Zachary Marwil, MD, managing director of Endoscopy Center of Long Island in Garden City, N.Y., told Becker’s. “Squeezing margins on these services that ASCs perform could force some centers to scale back, leaving patients with longer wait times, higher costs and fewer screening options.”
Omar Khokhar, MD, managing partner of Bloomington, Ill.-based Illinois GastroHealth, said lower pay could push patients toward hospitals.
“Reducing reimbursement simply delays access to care, and those patients will end up in the acute setting, which is ultimately more expensive and associated with poorer clinical outcomes,” he said.
Nirav Shah, MD, president of US Digestive Health’s DDA division in Wyomissing, Pa., said the update “fails to keep pace with escalating labor, supply, technology and regulatory costs.”
He added that CMS keeps encouraging care to move to outpatient settings, “but that strategy is difficult to sustain when reimbursement for the procedures we perform every day continues to decline.”
Terry Bohlke, CEO of Nashville, Tenn.-based Keystone Surgical Partners, told Becker’s he expects demand to cushion the cut. The population is aging, and screening is still rising among younger adults since the U.S. Preventive Services Task Force lowered the recommended screening age from 50 to 45 in 2021. He cited screening colonoscopy rates of 18% among 45- to 49-year-olds and 43% among 50- to 54-year-olds. Overall colorectal cancer screening, by any method, was higher in 2023: 36.1% and 55.6%, according to an analysis of National Health Interview Survey data published in The American Journal of Managed Care.
Mr. Bohlke expects GI procedures in ASCs to grow 24% over 10 years.
“Case volume tailwinds for GI far outweigh Medicare’s ASC reimbursement cut,” Mr. Bohlke said.
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.
