2026 Gastroenterology Reimbursement and Coding Update (On-Demand) | November 2025-The Other E&M We Do But (commonly) Forget to Bill For

Pdf Summary

This presentation by Dr. Glenn Littenberg focuses on the less commonly billed Evaluation & Management (E&M) services in gastroenterology (GI) for 2026, emphasizing ways to capture professional fees beyond procedural billing. It highlights the persistent decline in procedural fee schedules over recent years, with a temporary 2026 increase due to congressional action, and stresses the importance of billing for "other" E&M services that are performed frequently but often overlooked.<br /><br />Key "other" billable services include transitional care, portal message management (online digital E/M), telephone-based virtual check-ins, interprofessional consultations (eConsults), chronic care management (CCM), principal care management (PCM), remote patient monitoring (RPM), and remote therapeutic monitoring (RTM). The presentation explains specific CPT codes for these services, requirements (e.g., patient consent, time thresholds), documentation tips, and recent CPT changes such as the replacement of G2012 with 98016 for brief virtual check-ins.<br /><br />Examples given show billing scenarios for online portal message management (99421-99423), virtual check-ins (G2010, 98016), and eConsultations (99446-99449, 99451-99452). It emphasizes Medicare rules including that most of these services are for established patients, cannot be billed if related to a recent or imminent E/M visit, and require proper documentation of medical decision making and patient consent.<br /><br />New in 2026 is CPT 98979 for remote therapeutic monitoring treatment management with real-time communication, allowing shorter RTM billing periods.<br /><br />Additional underutilized services include home health certifications, care plan oversight (e.g., home TPN), tobacco cessation counseling, and nutrition/obesity management.<br /><br />Resources from ASGE and CMS are provided for coding guidance. The overall message encourages GI practitioners to leverage these alternative E&M codes to offset declining procedural revenue and optimize practice reimbursement.

Asset Subtitle

Glenn D. Littenberg, MD, MACP, FASGE

Keywords

Evaluation and Management (E&M) services

Gastroenterology billing 2026

Professional fee capture

Procedural fee schedule decline

Transitional care billing

Portal message management codes

Virtual check-in CPT codes

Interprofessional consultations (eConsults)

Chronic and principal care management

Remote therapeutic monitoring (RTM) CPT 98979