Proposed rules include changes to RVUs for services and PE methodology
ACG, AGA, and ASGE previously shared an overview of CMS’ proposed payment rules for 2026. There are two specific proposals within the regulation that have significant implications:
- A –2.5% efficiency adjustment to the work relative value units (RVUs) for non-time-based services, and
- A revision to the practice expense (PE) methodology that would significantly cut payments to physicians for facility-based services, such as those performed in hospital outpatient departments (HOPDs) and ambulatory surgical centers (ASCs).
For a deeper dive into the proposed rules and their impact on GI providers, read our full summary.
What this means for your practice:
- ASCs and HOPDs: Practices that provide ASC and hospital outpatient department (HOPD) endoscopy will experience an average 8% cut in physician payments for endoscopy compared to 2025 Medicare rates.
Each time you perform a colonoscopy with biopsy (45385), you’ll be paid $14.65 less than 2025. For colonoscopy with snare polypectomy (45385), it will be $18.00 less per procedure. You’ll also see an average 9% cut in E/M payments.
- Office-based practices: Practices that provide office-based endoscopy will experience an average 16% increase in endoscopy revenue over 2025 Medicare rates.
Each time you perform EGD with dilation <30 mm (43249), you’ll be paid $194.01 more than 2025 Medicare rates. You’ll also get an 8% increase in E/M payments.
- Future payments: We expect more payment cuts in 2027 when one-time payment increases from the One Big Beautiful Bill Act (H.R. 1) expire and physicians experience the full impact of the CMS proposals. Additionally, CMS will cut most physician work payments by 2.5% every three years as part of the “efficiency adjustment.”
Per procedure gains/losses to physician payments for the top GI endoscopy codes
Per procedure gains/losses to physician payment for top GI E/M codes
Overall impact to GI endoscopy and E/M
Next Steps
The GI societies urge CMS to disclose the underlying data, assumptions, and methodology used to justify the proposed 2.5% efficiency adjustment, and to reconsider the use of blanket reductions across a broad spectrum of procedural services that vary widely in complexity and clinical intensity.
We will be pushing for a more accurate, specialty-specific approach to indirect PE allocation for facility-based care—one that reflects the true resource needs of delivering high-quality GI services in hospital and ASC settings. The CY 2026 PFS Proposed Rule is open for public comment through September 12, 2025.
Take Action: You can help by contacting CMS directly to share your practice-level data and how these policies will impact patient care. Get started using our advocacy tool.
This is crucial to ensure that gastroenterology services are fairly valued and sustainably reimbursed—both now and into the future.