CMS has steadily expanded colorectal cancer screening coverage over the past three years by lowering the screening age to 45, adding coverage for blood-based biomarker tests and CT colonography, and eliminating patient cost-sharing for follow-up colonoscopies after positive noninvasive screening tests. These changes are expected to increase screening participation and drive more patients into ambulatory surgery centers (ASCs) for colonoscopy.
However, the increase in procedure volume is being offset by lower reimbursement. Under the 2026 Medicare payment changes, gastroenterologists performing endoscopy in ASCs and hospital outpatient departments face an average 8% reduction in physician payments, driven by adjustments to work RVUs and practice expense calculations. Common procedures such as colonoscopy with biopsy and snare polypectomy will receive lower payments than in 2025, while office-based endoscopy will see a 16% payment increase, creating financial incentives to shift procedures out of ASCs.