CMS Releases CY2026 Hospital OPPS and ASC Proposed Rule

American College of Gastroenterology. American Gastroenterological Association. American Society For Gastrointestinal Endoscopy.

On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the CY 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System proposed rule, outlining updates to Medicare payment policies and rates for hospital outpatient and ASC services. 

Here are the top takeaways: 

  • 2.4% payment increase for ASCs and hospital outpatient departments for those meeting quality reporting requirements.
  • Adding more than 500 procedures that can be performed in ASCs, including GI code POEM (CPT 43497). CMS also proposes relaxing criteria for adding procedures to the ASC Covered Procedures List (ASC CPL), which could open the door for the inclusion of more GI procedures and tests.
  • Cuts to drug administration payments to excepted off-campus provider-based departments. This would expand a method first implemented to control volume and remove the site-of-service differential for drug administration at clinic visits by reducing payments to the Physician Fee Schedule equivalent rate. This will impact GI drugs administered via infusion.

The GI societies are continuing our in-depth review of the proposed policies to gauge the impact on GI. We will provide additional analysis about the rules – including MPFS, HOPD, and ASC – with updates on how the proposed rules will impact you and how to get involved.

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About Gastrointestinal Endoscopy
Gastrointestinal endoscopic procedures allow the gastroenterologist to visually inspect the upper gastrointestinal tract (esophagus, stomach and duodenum) and the lower bowel (colon and rectum) through an endoscope, a thin, flexible device with a lighted end and a powerful lens system. Endoscopy has been a major advance in the treatment of gastrointestinal diseases. For example, the use of endoscopes allows the detection of ulcers, cancers, polyps and sites of internal bleeding. Through endoscopy, tissue samples (biopsies) may be obtained, areas of blockage can be opened and active bleeding can be stopped. Polyps in the colon can be removed, which has been shown to prevent colon cancer.

About the American Society for Gastrointestinal Endoscopy
Since its founding in 1941, the American Society for Gastrointestinal Endoscopy (ASGE) has been dedicated to advancing patient care and digestive health by promoting excellence and innovation in gastrointestinal endoscopy. ASGE, with almost 17,000 members worldwide, promotes the highest standards for endoscopic training and practice, fosters endoscopic research, recognizes distinguished contributions to endoscopy, and is the foremost resource for endoscopic education. Visit and for more information and to find a qualified doctor in your area.

 

American Society for Gastrointestinal Endoscopy
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Media Contact

Andrea Lee
Director of Marketing and Communications
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ALee@asge.org