2026 Gastroenterology Reimbursement and Coding Update (On-Demand) | November 2025-Breaking News: 2026 Preview and Current Issues Impacting GI Practice

Pdf Summary

The presentation "Breaking News: 2026 Preview and Current Issues Impacting GI Practice," delivered by Kathleen Mueller, CPC, CCS-P, QMGC, QMC, ICD-10 Proficient, addresses key upcoming changes for gastroenterology (GI) practices in 2026. Key topics include updates to the 2026 Medicare Physician Fee Schedule (PFS), introduction of new CPT and ICD-10-CM codes, and ongoing challenges such as payer downcoding and regulatory compliance.<br /><br />Significant adjustments to the 2026 Physician Fee Schedule include a new conversion factor—33.57 for clinicians in Advanced Alternative Payment Models (APMs) and 33.40 for non-APM clinicians—reflecting modest payment increases. A -2.5% efficiency adjustment will reduce payments for non-time-based services but exempts office visits, behavioral health, maternity, and telehealth. Telehealth policies are expanded, eliminating frequency limits on critical care and inpatient visits and allowing permanent virtual supervision.<br /><br />The talk also highlights CMS HCPCS code G2211, an add-on for visit complexity in evaluation and management (E/M) visits pertaining to ongoing care of single, serious, or complex conditions, valued at 0.49 RVUs (~$15.53 Medicare allowable). Guidance and examples clarify appropriate documentation for billing with G2211 to optimize reimbursements.<br /><br />New CPT codes effective January 1, 2026, include 43889 (endoscopic sleeve gastroplasty with argon plasma), 91124 and 91125 (anorectal function studies), and 98979 (remote therapeutic monitoring with interactive communication). ICD-10-CM updates add new GI-relevant pain and genetic predisposition diagnoses, reflecting evolving clinical documentation needs.<br /><br />Additional topics cover proper use of colonoscopy codes, differentiation between screening versus diagnostic procedures, advanced endoscopy, pathology services, audit risks (OIG, RAC), combating payer downcoding, implications of artificial intelligence on practice, and strategies to strengthen revenue cycle management.<br /><br />Overall, the presentation equips GI providers with critical regulatory, coding, and reimbursement updates to optimize practice performance and compliance for 2026.

Asset Subtitle

Kathleen A. Mueller, RN, CPC, QMC, QGMC, CCS-P, ICD-10 Proficient

Keywords

2026 Medicare Physician Fee Schedule

Gastroenterology practice updates

CPT codes 43889 91124 91125 98979

ICD-10-CM GI codes

Physician Fee Schedule conversion factor

Telehealth policy expansion

CMS HCPCS code G2211

Payer downcoding challenges

Advanced Alternative Payment Models

Revenue cycle management GI