Gastroenterologist Salary Guide 2026: GI Physician Pay, ASC Ownership & Endoscopy Revenue

Gastroenterology is one of internal medicine's highest-compensated subspecialties, driven by high procedural volume and the ambulatory surgery center (ASC) ownership model that allows GI physician-owners to capture facility fee revenue on top of professional fee income. In 2026, employed gastroenterologists at health systems typically earn $420,000–$600,000, while GI partners at physician-owned endoscopy ASCs routinely reach $700,000–$900,000 or higher. This guide covers GI salary benchmarks by setting and subspecialty, the economics of ASC ownership, colonoscopy and endoscopy procedure billing, and the income premium for fellowship-trained advanced endoscopists.

Gastroenterologist salary by setting

• Private practice GI with ASC ownership (partner): $550,000–$900,000+; physician-owned endoscopy ambulatory surgery centers are the primary income engine for private GI groups; each colonoscopy or EGD performed at the physician-owned ASC generates a facility fee ($400–$1,500/procedure depending on complexity and payer mix) in addition to the physician's professional fee; productive GI partners performing 15–25 procedures/day and owning a share of the ASC regularly achieve this income level
• Employed gastroenterologist (health system): $420,000–$600,000; salary + wRVU productivity bonus; health system captures ASC and hospital endoscopy suite facility fees; employed model growing as health systems acquire GI practices and endoscopy centers; base salary higher than most internal medicine subspecialties; ceiling meaningfully lower than ASC ownership
• Advanced endoscopy (ERCP / EUS fellowship-trained): $480,000–$750,000; fellowship training in endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound (EUS) positions the physician for complex biliary, pancreatic, and luminal interventions; ERCP and EUS procedures reimburse substantially higher than standard colonoscopy; demand for advanced endoscopists exceeds supply at major referral centers
• Academic gastroenterology: $320,000–$480,000; medical school faculty; residency and fellowship training; protected research time; NIH grant supplementation for GI cancer biology, IBD, liver disease, and microbiome investigators; lower nominal pay but significant career development and subspecialty referral access
• Hepatology / transplant hepatology: $380,000–$580,000; chronic liver disease (cirrhosis, hepatitis C, NAFLD/MASH, autoimmune hepatitis), pre-transplant evaluation, post-transplant management; liver transplant programs concentrated at large academic and regional medical centers; MASH (metabolic-associated steatohepatitis) drug pipeline creating significant hepatology research opportunity
• Inflammatory bowel disease (IBD) specialist: $380,000–$580,000; Crohn's disease and ulcerative colitis management; biologic and small molecule prescribing (infliximab biosimilars, vedolizumab, ustekinumab, ozanimod, tofacitinib); some IBD specialists integrate in-office biologic infusion programs (buy-and-bill) adding revenue beyond E&M and endoscopy
• Pediatric gastroenterology: $240,000–$380,000; pediatric hospital and academic programs; IBD, eosinophilic esophagitis, GI motility, liver disease; lowest-paying GI subspecialty due to pediatric E&M reimbursement dynamics and lower endoscopy volume in pediatric populations
• Motility specialist: $340,000–$520,000; esophageal manometry, pH-impedance testing, anorectal manometry, gastric emptying scintigraphy; specialty procedural expertise; concentrated in academic motility centers and large GI group practices

ASC ownership economics in gastroenterology

Ambulatory surgery centers are the defining wealth-building vehicle for private practice gastroenterologists, and understanding the economics is essential for evaluating any GI practice opportunity:

• Facility fee per procedure: A standard colonoscopy at a Medicare-contracted ASC generates $350–$600 in facility fees; commercial payers reimburse $600–$1,500 per colonoscopy; an EGD (upper endoscopy) generates $300–$750; complex procedures (colonoscopy + polypectomy + biopsy) bill at higher facility fee rates
• Volume scale: A 2-room endoscopy ASC running 30–50 procedures/day generates $3,000,000–$8,000,000+ in annual facility fee revenue; physician-owner GIs receive distributions based on their ownership percentage and personal case contribution; a 20% owner GI performing 25% of cases might receive $400,000–$800,000/year in ASC distributions on top of professional fee income
• Partnership track: Most private GI practices bring new associates in on a 2–4 year partnership track; associate-level compensation is $320,000–$450,000 during the pre-partner period; the income jump at full partnership with ASC equity is typically $150,000–$300,000+
• JV (joint venture) ASCs: Some GI groups enter joint ventures with hospital systems for ASC ownership; hospital-GI JV structures vary widely; physician income from JV ASCs is generally lower than purely physician-owned but higher than health system employed models
• CMS and commercial payer pressures: Site-neutral payment policies have been a concern for ASC economics; however, endoscopy remains largely preserved from the most aggressive site-neutral proposals as of 2026 because outpatient colonoscopy at an ASC is demonstrably more cost-effective than hospital outpatient department endoscopy; commercial payer steering has been more impactful in some markets

Colonoscopy and endoscopy procedure billing

GI procedural billing is among the most well-developed in internal medicine subspecialties. Key procedure codes and revenue benchmarks:

• Screening colonoscopy (CPT 45378): $250–$500 professional fee; $350–$1,200 facility fee at ASC; most common GI procedure; colorectal cancer screening drives volume; competitive specialty scheduling capacity
• Colonoscopy with polypectomy (CPT 45380–45385): $350–$650 professional fee depending on complexity (hot biopsy, cold snare, hot snare, EMR); add-on facility fee for polypectomy complex removals
• EGD (CPT 43239 with biopsy): $200–$400 professional fee; H. pylori testing, celiac biopsy, Barrett's surveillance, PEG tube placement at higher end
• ERCP (CPT 43264 with removal of biliary stone): $800–$1,800 professional fee; highest-reimbursing standard endoscopy procedure; sphincterotomy, stone extraction, stent placement add complexity codes
• EUS (CPT 43242 with fine needle aspiration): $600–$1,400 professional fee; pancreatic mass evaluation, lymph node staging, submucosal lesion characterization; advanced endoscopy specialist required
• Capsule endoscopy (CPT 91110–91111): $350–$700 professional fee; small bowel evaluation; image reading adds 30–60 min physician time post-procedure

Geographic variation in GI compensation

• Sun Belt (FL, TX, AZ, GA): $480,000–$850,000; aging population with high colorectal cancer screening demand; physician-owned endoscopy ASC culture well-established; FL and TX large independent GI group market
• Midwest: $420,000–$700,000; Cleveland Clinic, Mayo, large multispecialty groups anchor academic GI market; strong independent group market in mid-size cities
• Northeast / Mid-Atlantic: $420,000–$680,000; large academic center presence; hospital systems competitive for GI practice acquisition; New York and New England markets with strong payer mix
• Rural / underserved markets: $380,000–$600,000; colonoscopy access gaps in rural markets; some rural hospitals offering significant sign-on bonuses ($80,000–$120,000) to recruit GI coverage for areas lacking endoscopy capacity

What we see at Ava Health

Gastroenterology recruiting is highly active — particularly for associate-to-partner track positions at established private group practices with ASC infrastructure. GI physicians in our network who are evaluating their first attending position often underestimate the significance of the ASC partnership timeline; a 2-year vs. 4-year partnership track at the same base salary represents a $300,000–$600,000 difference in total income over the first 5 years of practice. We make a point of helping candidates evaluate the full partnership structure, ownership percentage, buy-in terms, and case volume projections when assessing any private GI practice offer — because the ASC economics are often the largest long-term income variable in the offer.

Related: Internal Medicine Physician Salary Guide, General Surgeon Salary Guide, Hepatologist Salary Guide, Physician Assistant Salary Guide.