GI Unit Leadership: Shaping a High-Performing Endoscopy Unit (Virtual) | February 2026-Changes to the Reimbursement Landscape

Video Transcription

Video Summary

The speaker discusses gastrointestinal (GI) reimbursement trends impacting endoscopy units, hospital outpatient departments (HOPD), ambulatory surgery centers (ASC), and physician payments. Despite slight increases, physician payments have seen minimal inflation adjustment over 25 years, lacking a sustainable mechanism tied to inflation. Facility payments through Ambulatory Payment Classifications (APCs) are bundled, with ASCs receiving about 53% of HOPD reimbursements, highlighting significant site neutrality issues. Payment trends show modest increases except for some common endoscopies, which face slight decreases. Accurate coding is emphasized for proper reimbursement. New procedures, like gastric restrictive surgeries and ESD, have emerging codes and evolving coverage. The ASC environment benefits from new physiologic procedure codes but faces complex billing modifiers (e.g., 59, 73, 74). Physician payments face cuts due to CMS efficiency adjustments and reduced practice expense allocations, lowering fees by 7-9%. Despite challenges, progress in coverage for bariatric endoscopy and related services offers growth opportunities. Resources and guides are available to navigate reimbursement complexities.

Asset Subtitle

Glenn Littenberg, MD, MASGE, MACP

Keywords

GI reimbursement trends

endoscopy units

physician payments

Ambulatory Payment Classifications

ASC vs HOPD reimbursement

bariatric endoscopy coverage