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

Pdf Summary

This document by Dr. Glenn Littenberg addresses often overlooked or forgotten Evaluation and Management (E&M) services in gastroenterology (GI) practices for 2026 billing. It highlights a gradual decline in procedural compensation over recent years, with a slight Congressional increase for 2026. Given falling fees for procedural E&M services, the document emphasizes capturing revenue through other frequently performed but underbilled services ("Other Codes").<br /><br />Key alternative billing opportunities include:<br />- Transitional care services<br />- Portal, telephone, and online digital communications (distinct from telehealth)<br />- Chronic care management (CCM) and principal care management (PCM) for single or multiple chronic conditions<br />- Remote patient monitoring (RPM)<br />- Home health certifications and care plan oversight, especially for enteral feeding or home TPN patients<br />- Nutrition services, obesity management, integrative health, and behavioral health offerings<br />- Non-covered services like breath tests, prep kit sales, and supplements<br /><br />The document explains coding, documentation, and Medicare rules for new services such as:<br />- Online digital E/M codes (99421-99423) for patient-initiated messages via secure platforms<br />- Virtual check-in codes (G2010, 98016) for brief provider-patient communications involving image or video reviews or short discussions not related to recent or imminent visits<br />- eConsults (99451-99452) for interprofessional consults without direct patient face-to-face encounters<br />- Chronic care management and principal care management codes indicating time spent monthly by physicians or clinical staff on managing chronic conditions<br /><br />Medicare payment rates and associated relative value units (wRVUs) are provided for these services, emphasizing their financial impact as procedural fees decline. The document calls for awareness of documentation and billing requirements, such as obtaining patient consent and avoiding overlapping claims.<br /><br />Finally, it includes useful coding and reimbursement resources from CMS and ASGE for GI practitioners to optimize billing for these supplemental services that support patient care and enhance practice revenue.

Asset Subtitle

Glenn D. Littenberg, MD, MACP, FASGE

Keywords

Evaluation and Management (E&M) services

Gastroenterology billing 2026

Procedural compensation decline

Alternative billing codes

Transitional care services

Chronic care management (CCM)

Remote patient monitoring (RPM)

Online digital E/M codes

Virtual check-in codes

Medicare reimbursement guidelines