Despite conversion factor increase, practice expense changes and misguided ‘efficiency’ adjustments may harm GI patients
On Oct. 31, the Centers for Medicare and Medicaid Services (CMS) released the final payment rates for physician services for calendar year (CY) 2026.
Top takeaways for GI:
Conversion factor (CF) increases to $33.40 for most physicians: CMS finalized increases to the CF for 2026, reflecting several statutory adjustments. This includes the one-time 2.5% positive adjustment passed by Congress as part of the “One Big Beautiful Bill,” a positive 0.49% budget-neutrality adjustment resulting from misvalued code changes, and the -2.5% efficiency adjustment.
Beginning in 2026, there will be two CFs, depending on whether a physician is an alternative payment model (APM) qualified participant. For providers meeting APM participation thresholds, CMS finalized a CY 2026 CF of $33.57, an increase from the CY 2025 CF of $32.35; for non-APM participants, the CY 2026 CF is $33.40.
Payment increases for office-based services, cuts for ASC/hospital-based services: CMS finalized changes to how physician practice expenses are calculated, despite warnings from the GI societies and our members about the impact of this proposal on high-quality GI care. The change results in significant payment increases for office-based services and significant cuts for services performed in the ASC and hospital-outpatient setting. This new policy also fails to distinguish between physicians who are hospital employed versus those who are private practice, or physicians in private practice who typically perform procedures in an ASC.
New “efficiency adjustment” cuts RVUs for GI procedures: The GI societies are extremely disappointed that CMS finalized a misguided “efficiency adjustment” policy, cutting 2.5% to work RVUs for endoscopy and other non-time-based codes. CMS claims clinicians become continuously efficient over time and cites the low response-rate to the current provider-survey process as inflating the time to perform the service. This policy also eclipses the increased 2026 CF the GI societies advocated Congress to include over the summer. These “efficiency” cuts would be recalculated and applied every three years with no floor for how much a service could be devalued.
In a minor modification to the proposed rule, CMS exempted procedures with new 2026 CPT codes, including endoscopic sleeve gastroplasty (43889), periauricular placement of a non-implanted percutaneous electrical nerve field stimulator (64567), and new anorectal manometry (91125) and barostat codes (91124), which will replace deleted codes 91120 and 91122.
Direct supervision via telehealth: In positive news, CMS is finalizing its proposal to permanently allow virtual direct supervision for most services that require supervision. In addition, CMS will continue to allow teaching physicians to provide virtual supervision to residents providing telehealth services in all training sites, not just in rural areas.
As of Tuesday, CMS has not released the final CY 2026 Medicare outpatient facility fees and related policy changes.
Payment Charts
2026 MPFS Final Rule GI Payment Changes
2026 MPFS Final Physician Work, PE and RVU Changes
Please note that the payments and RVUs reflected in these charts may reflect minor errors based on the information CMS provided. We are working with CMS to correct them.
Additional Resources
2026 MFPS Final Rule Press Release
2026 MPFS Final Rule Fact Sheet