The 2026 Reimbursement Math Doesn’t Add Up — How the Conversion Factor Increase Is Being Offset by RVU Reductions in GI

Section analysis by Oksana Pokoyeva, COC, CPC, CPCO, CPC-P, CPMA, CUC, Billing Department, WCH 

Editorial note: This article reflects CMS Physician Fee Schedule Final Rule data and ASGE/AGA published analysis current as of June–July 2026. Revenue impact figures represent analytical estimates based on published RVU changes — individual practice results vary by payer mix, case volume, and contract structure. This article is for informational and educational purposes and does not constitute financial or compliance advice.

The headline from CMS in late 2025 was straightforward: the Medicare conversion factor is increasing in 2026. For most gastroenterology practices, the working assumption was that this represented a meaningful positive development — a genuine reimbursement improvement after years of flat or declining Medicare revenue. By June and July 2026, that assumption is being revised in practices across the country, as revenue cycle teams and billing directors complete the recalculations that ASGE and AGA have been urging since the Final Rule was published. The net effect, once work RVU reductions are factored in, is a story that looks substantially different from the headline number — and for a specialty whose economics depend heavily on high-volume endoscopic procedures, the gap between the announced rate and the effective rate has real and calculable consequences..


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