S2232 Inflation and Medicare Reimbursement for Advanced Gastroenterology Procedures—ERCP and EUS From 2018 to 2025

Introduction: Consumer prices for advanced gastroenterology procedures increased by 25% from 2018 to 2025. We evaluated whether Medicare payments for advanced endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) kept pace. Methods: Medicare rate files from 2018 to 2025 were used to obtain reimbursement data for physician professional services, hospital outpatient departments (HOPDs), ambulatory surgery centers (ASCs), and inpatient Diagnosis-Related Group (DRG) payments. DRG 405, representing pancreas, liver, and shunt procedures with major complications or comorbidities (MCC), was selected as a representative code for advanced inpatient GI procedures. ERCP codes were grouped as diagnostic or therapeutic; EUS codes were divided into EUS only and EUS with fine needle aspiration or biopsy (FNA FNB). Nominal and inflation adjusted (25% Consumer Price Index deflator) percent changes were calculated. Results: Physician fees declined by 9.9% for diagnostic ERCP, 10% for therapeutic ERCP, 9.7% for EUS with FNA FNB, and 48.2% for EUS only; real decreases ranged from 28% to 59%. HOPD payments increased by 38.7% for diagnostic ERCP and 38.6% for therapeutic ERCP, fell 30.8% for EUS only, and rose 32.9% for EUS with FNA FNB; inflation adjusted changes were plus 11%, plus 11%, minus 45%, and plus 6% respectively. ASC payments rose by 54.8%, 92.2%, decreased by 28.7%, and increased by 37.8% for diagnostic ERCP, therapeutic ERCP, EUS alone and EUS with FNA FNB respectively, yielding real changes of plus 24%, plus 53%, minus 42.9%, and plus 10%, respectively. Inpatient payments increased 21.6% nominally but decreased 2.7% in real terms. Conclusion: From 2018 to 2025, inflation outpaced Medicare physician reimbursement for all advanced ERCP and EUS services, whereas most facility payments grew in real terms, especially in ASCs. The gap between professional and facility payment threatens the financial sustainability of complex endoscopy and supports indexing the physician conversion factor to inflation or reallocating part of facility growth to professional fees.