Navigating the 2026 MPFS Final Rule: Impact on Gastroenterology and Your Bottom Line

Pdf Summary

The virtual event "Navigating the 2026 MPFS Final Rule: Impact on Gastroenterology and Your Bottom Line," held on December 2, 2025, focused on key changes in the Medicare Physician Fee Schedule (MPFS) for 2026 and their implications for gastroenterology practices. Moderated by Drs. Glenn Littenberg and Edward Sun, the session examined updates including a 3.26% increase in the conversion factor to 33.40 and a new CMS-imposed 2.5% reduction on work RVUs for all non-time-based codes based on efficiency adjustments, aiming to reflect clinicians’ increased proficiency and reduce subjectivity in valuations. These efficiency cuts exclude Evaluation and Management (E/M) services.<br /><br />CMS also revised the Practice Expense (PE) methodology, differentiating payments by site of service to better account for indirect costs. Facility-based services (hospitals, HOPDs, ASCs) saw a 7% decrease in PE payments, while non-facility (office-based) services gained 4%. The overall impact translates to a 3% decrease in allowed charges for gastroenterology, with a 9% cut for facility-based and a 6% increase for non-facility reimbursements.<br /><br />Endoscopy reimbursements were notably affected: payments for ASC and hospital-based endoscopy are expected to drop by 8%, resulting in a $58 million decrease, while office-based endoscopy could see a 16% revenue increase. For example, colonoscopies with biopsy or polypectomy performed in ASCs or HOPDs will reimburse $15 to $18 less per procedure, whereas office-based EGD with dilation could increase by $194 per procedure compared to 2025.<br /><br />The session underscored the growing value of office-based endoscopy due to lower costs—average colonoscopy costs are roughly half in offices ($1,328) compared to facilities (HOPD $2,753, ASC $2,277). Panelists from leading gastroenterology centers and consultants provided insights to help practices adapt to these reimbursement shifts and optimize financial outcomes under the 2026 MPFS final rule.

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Concept Conversion Factor

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Concept Gastroenterology

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Keywords

2026 MPFS Final Rule

Medicare Physician Fee Schedule

Gastroenterology reimbursement

Conversion factor increase

Work RVU efficiency adjustment

Practice Expense methodology

Facility vs non-facility payments

Endoscopy reimbursement changes

Office-based endoscopy value

Medicare payment cuts

Medicare Physician Fee Schedule

Conversion Factor

Relative Value Unit

Gastroenterology

Endoscopy

Medicare Reimbursement