CMS on October 30 released the CY 2016 Physician Fee Schedule Final Rule. ACG, AGA and ASGE are outraged at the failure of CMS to accept the GI societies’ reimbursement recommendations. The cuts to the colonoscopy family of codes are inappropriately deep and, at their highest, slash payment for some colonoscopy procedures by more than 17 percent. The cuts proposed in July were as high as 20 percent, and ACG, AGA, and ASGE and thousands of our member gastroenterologists advocated strongly against these cuts.

The societies provided research-driven data to support the values recommended by our organizations.  The cuts in the Final Rule were not based on the data submitted; ultimately, our recommendations were disregarded. We intend to shine a light on this fact to Congress and the public.

In the months ahead, we will call on you to reach out to CMS and legislators on Capitol Hill, so that they can better understand the direct impact that these cuts are having on your practice and on patients.

Top 11 Lower GI Codes*
Below is a chart of the top 11 lower GI codes that were cut.

Top Lower GI Endoscopy Procedures
CPT Code Short Descriptor 2015 Physician work RVU CMS 2016 Proposed Physician work RVU Proposed RVU % change CMS 2016 Final Physician work RVU Final RVU % change
45380 Colonoscopy with biopsy 4.43 3.59 -19% 3.66 -17%
45385 Colonoscopy with snare polypectomy 5.30 4.67 -12% 4.67 -12%
45378 Colonoscopy 3.69 3.29 -11% 3.36 -9%
G0105 Colorectal cancer screen, high risk 3.36 3.29 -2% 3.36 0%
G0121 Colorectal cancer screen, low risk 3.36 3.29 -2% 3.36 0%
45384 Colonoscopy with hot biopsy 4.69 4.17 -11% 4.17 -11%
45381 Colonoscopy with submucosal injection 4.19 3.59 -14% 3.66 -13%
45388 Colonoscopy, flexible with ablation 5.86 4.98 -15% 4.98 -15%
45331 Flexible sigmoidoscopy with biopsy 1.15 1.07 -7% 1.14 -1%
45330 Flexible sigmoidoscopy 0.96 0.77 -20% 0.84 -13%
45382 Colonoscopy with control of bleeding 5.68 4.76 -16% 4.76 -16%
* 45383 was deleted in CPT 2015 and replaced by 45388. CMS instead is using G6024, the equivalent of 45383, for CY 2015.


Next week, we will provide a summary of reimbursement changes. In the coming weeks, we will provide more detailed information and resources to help practices prepare for payment and policy changes.

ACG, ASGE and AGA are committed to working together to fight for fair reimbursement for GI procedures. Watch your email for updates on this important issue.