Pediatric Surgeon Salary Guide 2026: Neonatal Surgery, Oncology, and Children's Hospital Income

Pediatric surgeon salary overview 2026

Pediatric surgery is a general surgery subspecialty dedicated to surgical care of infants, children, and adolescents. Physicians complete a 5-year general surgery residency followed by a 2-year pediatric surgery fellowship — the longest training pathway in general surgery. Mean total compensation in 2026 ranges from $400,000–$620,000 in academic children's hospital settings and $450,000–$700,000 at employed community children's hospitals and pediatric programs within health systems. Pediatric surgery is almost exclusively an academic or health-system-employed specialty — the patient population, hospital infrastructure requirements, and complexity of neonatal and oncologic cases create near-universal health system employment. Very few truly private pediatric surgery practices exist outside of outpatient pediatric surgery centers in select markets.

Income by practice setting and subspecialty emphasis

• Academic children's hospital (university-affiliated): $400,000–$580,000; highest complexity cases — neonatal surgery, pediatric oncologic resection, pediatric trauma, complex GI malformations; APSA fellowship training program; NIH and departmental research infrastructure; NIDDK, NCI, and NICHD grant access; lowest nominal income but deepest case complexity and academic career development
• Employed freestanding children's hospital (non-university-affiliated): $450,000–$650,000; full-scope pediatric surgery program; neonatal and pediatric ICU support; pediatric anesthesia and intensivist collaboration; administrative compensation for surgical quality program leadership; strongest income in the specialty for non-academic pediatric surgeons
• Pediatric surgery within a general hospital system: $430,000–$620,000; general hospital with dedicated pediatric surgery service; neonatal cases transferred from community hospitals; outpatient pediatric surgery clinic; overlap with adult general surgery in smaller programs; higher call burden because pediatric call is add-on to general surgery coverage at some institutions
• Outpatient pediatric surgery center / pediatric surgical group: $450,000–$680,000; elective outpatient procedures — inguinal hernia, circumcision, appendectomy, laparoscopic procedures; lower intensity than inpatient neonatal/trauma scope; growing in markets where children's hospital and outpatient pediatric surgery center collaboration enables appropriate procedure-setting migration

Procedure-level billing

• Appendectomy (pediatric laparoscopic): CPT 44950 (open) / 44960 (with perforation) / 44970 (laparoscopic); professional fee $1,500–$3,000; most common emergent procedure in pediatric surgery; high volume drives significant revenue base even at a per-case fee below adult surgical subspecialties
• Pyloromyotomy (Ramstedt): CPT 43520; professional fee $1,500–$2,500; hypertrophic pyloric stenosis in infants 4–8 weeks; laparoscopic approach (CPT 43520 with approach modifier) standard at pediatric programs; quick procedure but high clinical stakes in neonatal patient
• Inguinal hernia repair (pediatric): CPT 49495 (infant, reducible) / 49496 (infant, incarcerated) / 49500 (child, reducible) / 49501 (child, incarcerated); professional fee $1,200–$2,500; high volume outpatient procedure; bilateral repair generates bilateral modifier billing; hydrocele repair (CPT 55040-55060) often combined
• Nissen fundoplication (laparoscopic pediatric anti-reflux): CPT 43280 (laparoscopic) / 43327 (with esophageal lengthening); professional fee $2,500–$4,500; pediatric GERD with failure of medical management, neurologically impaired children with aspiration risk; concurrent G-tube placement (CPT 43246) common
• Gastrostomy tube placement: CPT 43246 (endoscopic, with PEG) / 43653 (laparoscopic); professional fee $1,000–$2,000; feeding access for neurologically impaired children, failure to thrive, esophageal anomalies; high volume at children's hospitals with complex medical patient populations
• Congenital diaphragmatic hernia (CDH) repair: CPT 39502 (repair, neonatal) / 39541 (repair, post-neonatal); professional fee $4,000–$8,000; high-complexity neonatal surgery; ECMO collaboration required in severe cases; postoperative care intensive; concentrated at major neonatal surgery programs
• Esophageal atresia / TEF repair: CPT 43210 (esophageal anastomosis, thoracoscopic) / 43300 (esophageal reconstruction); professional fee $5,000–$10,000; neonatal esophageal atresia with or without tracheoesophageal fistula; thoracoscopic repair at high-volume programs; highest-acuity neonatal surgical emergency after CDH
• Gastroschisis / omphalocele repair: CPT 49600-49611 (omphalocele repair by size) / 49900 (gastroschisis); professional fee $3,000–$7,000; abdominal wall defect repair in neonates; gastroschisis repair often staged (silo placement then delayed closure); high NICU cost but professional fee billing is for the operative component
• Hirschsprung's disease pullthrough: CPT 45116 (transanal endorectal pullthrough) / 45113 (laparoscopic-assisted); professional fee $4,500–$8,000; aganglionic colon resection with coloanal anastomosis; neonatal or infant procedure; long-term follow-up clinic billing for motility management
• Nephrectomy for Wilms tumor: CPT 50220 (radical) / 50225 (with regional lymph nodes); professional fee $2,500–$5,000; most common renal malignancy in children; NWTS protocol chemotherapy coordination with pediatric oncology; bilateral Wilms requires nephron-sparing approach (higher professional fee)
• Neuroblastoma resection: CPT 60260 (adrenal gland surgery) / 49215 (retroperitoneal mass excision); professional fee $3,500–$7,000+ depending on complexity; complex retroperitoneal dissection around major vessels; highest-RVU pediatric oncology procedure category
• Thoracoscopic surgery (VATS/thoracoscopy): CPT 32607 (VATS, with biopsy) / 32608 (lung biopsy) / 32650 (pleurodesis) / 32651 (partial lung resection); professional fee $2,500–$5,000; pediatric empyema, lung mass biopsy, spontaneous pneumothorax, CCAM (congenital cystic adenomatoid malformation) resection

wRVU benchmarks and call structure

Pediatric surgeons generate high per-case RVUs for neonatal and oncologic procedures but at lower annual volume than adult surgical subspecialties. MGMA data places pediatric surgery median total wRVUs at 6,000–9,000/year, with conversion factors of $65–$95/wRVU. The call burden is a defining variable: pediatric surgery is 24/7 on-call for pediatric surgical emergencies — appendicitis, bowel obstruction, intussusception, testicular torsion, trauma — at any program with inpatient pediatric capability. Programs with 2+ pediatric surgeons share call more effectively; single-surgeon programs carry 24/7 call with backup strategies that significantly affect quality of life.

Geographic variation in pediatric surgeon compensation

• Major children's hospital networks (CHOP, Boston Children's, Cincinnati Children's, Children's National, Texas Children's, UCSF Benioff, Children's Minnesota): $430,000–$640,000; highest case volume and complexity; neonatal surgery and pediatric oncology concentration; strongest academic career development platform; research grant supplement available
• Regional children's hospitals and pediatric-within-general (250–400 bed): $450,000–$660,000; full-scope clinical service; stronger elective and trauma pediatric surgery volume per surgeon; less specialization within subspecialty; often the highest clinical income range in pediatric surgery
• Sun Belt growth markets (FL, TX, AZ, GA): $460,000–$700,000; rapidly expanding pediatric population drives program growth; FL and TX children's hospital networks (Florida Children's, Texas Children's, Cook Children's, Nicklaus) adding surgical capacity; competitive employed market

What we see at Ava Health

Pediatric surgery is a specialty where the training investment (9 years post-medical school including 2-year fellowship) and the clinical responsibility are high, but where the nominal compensation — while strong — often doesn't fully reflect the intensity relative to adult surgical subspecialties of comparable training length. The pediatric surgeons in our network are nearly unanimous in citing their patient population and case variety as the primary career driver. For children's hospitals recruiting pediatric surgeons, the most effective pitch beyond compensation is the program's neonatal surgery complexity and volume — surgeons who trained in high-volume neonatal programs consistently prioritize access to complex neonatal cases over salary when evaluating their first or second attending position. Administrative burden (call structure, documentation requirements, hospital credentialing processes) is the most frequently cited friction point in retention of practicing pediatric surgeons.

Related: General Surgeon Salary Guide, Neonatologist Salary Guide, Hematologist-Oncologist Salary Guide, Colorectal Surgeon Salary Guide.