Colorectal Surgeon Salary Guide 2026: Colon and Rectal Surgery Income Breakdown

Colorectal surgeon salary overview 2026

Colorectal surgery (formally "colon and rectal surgery") is a surgical subspecialty that encompasses cancer surgery, inflammatory bowel disease, benign anorectal disease, and complex abdominal wall and pelvic floor reconstruction. Mean total compensation in 2026 ranges from $350,000–$550,000 in academic settings, $400,000–$680,000 for employed community and health-system colorectal surgeons, and $550,000–$1,000,000+ for colorectal surgeons in private practice — particularly those with ambulatory surgery center ownership or robotic surgery program leadership. The wide range reflects variation in case mix complexity (cancer vs. benign), operative volume, geographic market, and ownership of the technical component through ASC participation.

Income by practice setting

• Academic colorectal surgery: $350,000–$550,000; complex cancer surgery, IBD surgery, and pelvic floor reconstruction; significant fellow/resident teaching component; research on minimally invasive technique outcomes, rectal cancer neoadjuvant therapy, and IBD surgical management; lower income offset by academic reputation and complex case volume
• Employed community hospital / health system: $400,000–$680,000; wRVU production structure typical; base plus bonus above threshold; colorectal surgery programs at 300–700 bed community hospitals serve strong cancer surgery and IBD referral populations; robotic colorectal surgery capability increasingly expected
• Private practice colorectal surgery group: $550,000–$1,000,000+; physician-owned multispecialty or single-specialty surgical groups with ASC ownership generate facility fee revenue from colonoscopy, hemorrhoidectomy, and flexible sigmoidoscopy performed in the ASC; the ASC technical component economics are the primary income amplifier in private colorectal surgery
• Solo or small group private practice: $500,000–$900,000; declining model nationally as health system employment and PE consolidation grow; remaining solo and small-group colorectal surgeons typically have strong community roots and established ASC participation that makes the economics viable

Procedure-level billing: how colorectal surgeons earn

• Colonoscopy (diagnostic and therapeutic): CPT 45378 (diagnostic), 45380 (with biopsy), 45384/45385 (polypectomy); professional fee $350–$700 per procedure; when performed in physician-owned ASC, total (professional + technical) revenue $800–$2,500; high-volume colorectal surgeons performing 200–400 colonoscopies/year in their own ASC generate $160,000–$1,000,000 in total colonoscopy revenue including the technical component
• Sigmoid colectomy / left colectomy: CPT 44204 (laparoscopic) / 44140 (open); professional fee $2,000–$4,500; performed for diverticular disease, Crohn's, and sigmoid colon cancer; most commonly performed colon resection procedure
• Right hemicolectomy / ileocolectomy: CPT 44205 (laparoscopic) / 44160 (open); professional fee $2,000–$4,000; right colon cancer, Crohn's ileocolitis, cecal volvulus
• Total abdominal colectomy (TAC): CPT 44150 (with ileostomy) / 44152 (with ileoproctostomy); professional fee $3,000–$5,500; urgent colectomy for severe UC or C. difficile colitis; significant postoperative management billing
• Low anterior resection (LAR): CPT 44207 (laparoscopic) / 44145 (open); professional fee $3,000–$6,000; sphincter-preserving rectal cancer surgery with colorectal or coloanal anastomosis; one of the highest-RVU colorectal procedures; robotic LAR increasingly preferred for mid-low rectal cancer (pelvis visualization advantage)
• Abdominoperineal resection (APR): CPT 45110; professional fee $3,500–$6,500; permanent colostomy for low rectal cancer below the sphincter complex; perineal dissection adds significant RVU to the base colectomy code
• IPAA / J-pouch (ileal pouch anal anastomosis): CPT 44211 (laparoscopic total proctocolectomy with IPAA); professional fee $5,000–$9,000; restorative proctocolectomy for ulcerative colitis; staged in 2–3 operations; highest RVU procedure category in colorectal surgery; complex pouch complications (pouchitis, pouch failure) generate ongoing management billing
• Transanal minimally invasive surgery (TAMIS) / TaTME: CPT 45174 (TAMIS transanal excision of rectal tumor); professional fee $2,500–$5,000; TAMIS for early T1 rectal lesions and TaTME for low rectal cancer allows sphincter preservation in anatomically challenging cases; surgeon training and certification requirements limit adoption to high-volume centers
• Diverting loop ileostomy: CPT 44310; professional fee $1,500–$2,500; protective stoma for low anastomosis or rectal pouch construction; ileostomy reversal (CPT 44620-44625) generates separate billing 8–12 weeks post-index surgery
• Hemorrhoidectomy: CPT 46250 (external, 2 columns), 46255 (internal + external, 2 columns), 46260 (internal + external, 3+ columns); professional fee $800–$2,000; stapled hemorrhoidopexy (CPT 46947) $1,000–$2,500; when performed in physician-owned ASC, total revenue significantly higher than hospital-based procedure
• Anal fistula repair: CPT 46270 (intersphincteric) / 46275 (transphincteric) / 46285 (second stage); professional fee $1,200–$2,800; ligation of intersphincteric fistula tract (LIFT) procedure popular for complex trans-sphincteric fistulas; advancement flap (CPT 46288) for complex cases
• Anal fissure treatment: CPT 46080 (sphincterotomy); professional fee $800–$1,500; lateral internal sphincterotomy remains the gold standard for chronic anal fissure; quick, high-volume procedure in ambulatory setting
• Transanal excision of rectal polyp/tumor: CPT 45171 (transanal excision, less than 3 cm), 45172 (complex); professional fee $1,500–$3,500; benign polyps not amenable to colonoscopic removal and selected T1 rectal cancers

ASC ownership: the primary income amplifier

Colorectal surgeons who own or partner in an ambulatory surgery center capture the technical component billing for procedures they perform at that facility. The economic impact is substantial: a colonoscopy with polypectomy generates a professional fee of $500–$700 and an ASC technical fee of $600–$1,200 (Medicare allowable). A surgeon performing 300 colonoscopies per year at their own ASC earns the $500–$700 professional fee plus an ownership share of $600–$1,200 per procedure in technical revenue — effectively doubling per-procedure income. Hemorrhoidectomies, anal fistula repairs, and transanal procedures similarly benefit from ASC technical fee capture. Colorectal surgeons with active ASC ownership consistently earn 40–80% more than equivalently productive surgeons performing the same procedures at hospital facilities.

Robotic colorectal surgery

Da Vinci robotic system certification is increasingly expected for academic and high-volume community colorectal surgeons. Robotic low anterior resection and right hemicolectomy offer superior pelvic visibility and wristed instrumentation that facilitate sphincter-preserving dissection in narrow male pelvises. Robotic cases do not generate separate professional fee premium — billing codes are identical to standard minimally invasive procedures — but robotic capability attracts complex referral cases (obese patients, narrow pelvises, recurrent rectal cancer) that increase case RVU mix. Robotic platform costs ($1.5M–$2.5M for da Vinci Xi) are borne by the hospital or surgery center and do not directly affect the surgeon's income, but programs with robotic capability attract more subspecialty referrals from oncology and IBD programs.

Geographic variation in colorectal surgeon compensation

• Major urban markets (NYC, Chicago, Houston, LA): $450,000–$700,000 employed; $600,000–$1,000,000+ private; NCI cancer center referral volume; complex IBD and rectal cancer programs; highest specialty density but also highest patient volumes
• Sun Belt community markets (FL, TX, GA, AZ): $480,000–$850,000; strong private practice colorectal surgery culture; FL and TX have active physician-owned ASC markets; aging population drives colonoscopy and colorectal cancer surgery volume; excellent income environment for private group colorectal surgeons
• Midwest and Southeast community programs: $400,000–$680,000; health-system employed model dominant in many markets; robotic program adoption accelerating; diverticular disease and colorectal cancer volumes strong; IBD referral patterns to academic centers limit complex IBD surgical volume
• Rural and shortage areas: $400,000–$650,000; significant access gap for colorectal specialty care; general surgeons perform much of the colorectal work in rural markets; specialist colorectal surgeons who establish rural practices often have limited competition and strong hospital partnership economics

What we see at Ava Health

Colorectal surgery has one of the most pronounced income gaps between private-practice and health-system-employed physicians of any surgical subspecialty, largely because of ASC ownership economics. The candidates in our network who are most satisfied with their compensation are consistently those who either joined a partnership-track private group with ASC equity or negotiated ASC participation rights as a condition of employment with a health system that operates an ASC. For colorectal surgery programs recruiting experienced attendings, transparency about ASC participation — what the ASC structure looks like, what the partnership timeline is, and what the per-procedure economics are — is the most powerful differentiator in the negotiation. Candidates who are evaluating multiple offers without this information are almost always leaving money on the table.

Related: General Surgeon Salary Guide, Gastroenterologist Salary Guide, Hematologist-Oncologist Salary Guide, Vascular Surgeon Salary Guide.