Interventional Gastroenterologist Salary in 2026: ERCP, EUS, EMR, ESD, and POEM Compensation

Interventional gastroenterologists — also called advanced endoscopists or therapeutic endoscopists — are gastroenterologists who have completed additional one-to-two-year advanced endoscopy fellowship training beyond standard three-year GI fellowship and specialize in complex endoscopic procedures: endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), peroral endoscopic myotomy (POEM), and lumen-apposing metal stent (LAMS) placement for pancreatic fluid collection drainage. These are the highest-volume, highest-reimbursement procedures in gastroenterology. Interventional GI physicians routinely generate $600,000–$1,000,000+ in annual professional collections at high-volume centers, and even employed physicians taking a portion of collections typically earn $400,000–$700,000+ — significantly above general gastroenterology benchmarks.

Training and Certification

The pathway is three years of internal medicine residency, three years of GI/hepatology fellowship (ACGME-accredited), and then one to two years of advanced endoscopy fellowship at a high-volume center. There is no separate ABIM subspecialty board for advanced endoscopy as of 2026 — competence is established through fellowship training documentation and procedure volume logs. The American Society for Gastrointestinal Endoscopy (ASGE) has published competency thresholds: ERCP competency requires a minimum of 200 supervised procedures (with at least 80% native papilla cannulation success rate); EUS competency requires 150+ cases (FNA at 50+ cases). Advanced endoscopy fellowship programs are concentrated at academic medical centers performing high ERCP/EUS volumes — Stanford, Johns Hopkins, Penn, Duke, Mayo, Northwestern, Brigham and Women's. Most fellows complete two years to achieve adequate volume across all advanced endoscopy modalities; one-year fellowships are typically limited to ERCP-only training.

Key CPT Codes and Procedure Revenue

• ERCP without intervention (43260): Diagnostic ERCP ($300–$500 physician component Medicare); typically combined with therapeutic codes below when biliary intervention is performed
• ERCP with sphincterotomy (43262): Biliary sphincterotomy ($450–$650); the most common therapeutic ERCP procedure, used for bile duct stone extraction and stricture management
• ERCP with stent placement (43274): Endoscopic stent placement ($600–$900); used for biliary obstruction from pancreatic cancer, CBD stones, post-surgical strictures; plastic and self-expanding metal stents are billed differently
• ERCP with stone extraction (43264, 43265): Bile duct calculi removal ($550–$750); cholangioscopy-guided lithotripsy (43265) for large impacted stones generates the highest ERCP physician revenue
• EUS without FNA (43237–43238): Endoscopic ultrasound of the upper GI tract ($350–$500); staging of esophageal, gastric, and pancreatic tumors; evaluation of subepithelial lesions
• EUS with FNA/FNB (43242): EUS-guided tissue sampling ($500–$750); pancreatic mass biopsy, mediastinal lymph node sampling, celiac plexus neurolysis; fine-needle biopsy (FNB) has largely replaced FNA for pancreatic lesions due to higher diagnostic yield
• POEM (43497): Peroral endoscopic myotomy for achalasia ($1,200–$2,500 physician component commercial); one of the highest-reimbursed endoscopic procedures; limited to centers with POEM-trained physicians and appropriate anesthesia/monitoring infrastructure
• EMR (43211, 45346): Endoscopic mucosal resection for Barrett's esophagus with dysplasia or large colorectal polyps; $350–$700 per session; large/complex EMR (piecemeal resection of polyps >3cm) generates higher billing complexity
• LAMS placement (43240, 43253): Lumen-apposing metal stent for pancreatic pseudocyst or walled-off necrosis drainage; $800–$1,500 physician component; newer EUS-guided gastroenterostomy (EUS-GE) for malignant gastric outlet obstruction uses LAMS with evolving CPT coding
• Cholangioscopy/SpyGlass (43278): Direct visualization of the bile duct via single-operator cholangioscope; $400–$700; used for difficult biliary stone management and biliary stricture characterization

Salary Ranges by Practice Setting

• Academic medical center with high-volume advanced endoscopy program: $400,000–$580,000; academic advanced endoscopists combine high procedural volume with teaching, research (clinical trials in ERCP outcomes, ESD techniques, AI-assisted endoscopy), and fellow supervision; AAMC benchmark supplements add to base; PSLF-eligible; academic positions typically require 12–15 advanced procedures per week to hit wRVU targets
• Large private GI group with interventional track: $500,000–$700,000+; private practice advanced endoscopy physicians generate significant RVU-based income at production compensation rates of $55–$80/wRVU; ownership in the practice (ASC ownership, endoscopy center equity) adds additional income streams through facility fee revenue sharing; private practice advanced endoscopists commonly reach $650,000–$850,000 in total compensation when equity distributions are included
• Hospital-employed with productivity bonus: $420,000–$620,000; hospital employment with RVU-based production bonus is the predominant model for advanced endoscopists at community and regional referral centers; hospitals value advanced endoscopy services as a downstream revenue driver (pancreatic cancer staging, biliary intervention) that attracts surgical referrals
• Solo or small group advanced endoscopy center: $550,000–$900,000+; advanced endoscopists who own or co-own an accredited ambulatory surgical center with dedicated procedure rooms generate substantially higher income through both professional fees and ASC facility fee revenue; ERCP/EUS procedures are reimbursed at ASC rates significantly below hospital outpatient rates, limiting but not eliminating the financial advantage of ASC ownership for complex procedures

Geographic Variation and Referral Network Value

Advanced endoscopy income is highly dependent on referral network quality. ERCP and EUS generate significant downstream revenue for hospitals through surgical cases, oncology referrals, and related admissions — hospital systems in competitive markets value their advanced endoscopists as strategic assets and pay accordingly. Markets with dominant private GI groups (Florida, Texas, Tennessee, Georgia, Nevada) have the highest private practice compensation ceilings. Academic markets in the Northeast and California offer lower take-home but stronger research and training infrastructure. Rural and underserved markets increasingly use telemedicine consultation for initial GI referrals, but advanced endoscopy itself remains exclusively in-person, creating strong geographic demand for interventional GI physicians willing to serve regional referral centers that lack advanced endoscopy capability.

What we see at Ava Health

Advanced endoscopy is one of the highest-velocity recruiting segments in gastroenterology. Fellowship graduates are intensely recruited during their training year, with many programs pre-committing to positions 12–18 months before completion. For mid-career advanced endoscopists, the most active opportunities are from private GI groups seeking to add advanced endoscopy capability (and the corresponding surgical case attraction), and from hospital systems launching or rebuilding programs after departure of an existing advanced endoscopist. Compensation packages for experienced advanced endoscopists routinely include base salary, guaranteed production bonus (typically wrRVU above threshold), sign-on bonus ($50,000–$100,000 in competitive markets), and pathway to ASC equity. The candidates with the strongest negotiating leverage are those with both ERCP and EUS training at fellowship volumes above ASGE competency thresholds — these physicians are immediately credentialable and revenue-generating on day one, which hospitals value highly when filling a coverage gap.

Related: Gastroenterologist Salary Guide, Hepatologist Salary Guide, Colorectal Surgeon Salary Guide, General Surgeon Salary Guide.