Medicare & Ambulatory Surgery Center

Medicare Part B medical insurance covers service fees associated with approved surgical procedures at an ambulatory surgery center (ASC). To be covered, you should be expected to be released from the center within 24 hours of your surgery.

Medicare covers all procedures that do not pose a significant risk if they are performed in an ambulatory surgery center so long as they don’t require an overnight stay.

As of 2018, there were roughly 3,600 different types of procedures performed at ambulatory surgery centers covered by Medicare, according to the Medicare Payment Advisory Commission (MedPAC).

If you have Medicare Part B and have a procedure at an ambulatory surgery center, Medicare will cover up to 80 percent of the cost.

You are responsible for the Medicare Part B deductible and for 20 percent of the Medicare-approved cost of your procedure and 20 percent of the doctor fees.

You also have to pay all facility fees for any procedure that Medicare does not cover in an ambulatory surgery center.

Medicare covers all costs for certain preventive services performed in an ASC, so you’ll have no out-of-pocket costs for those services.

Ambulatory surgery centers are freestanding outpatient facilities. They may be run by hospitals but perform outpatient services — meaning procedures that can be done without requiring a patient be admitted to a hospital.

Hospitals are equipped to handle inpatient services — meaning you are admitted to a hospital and may stay there overnight or longer. Hospitals also typically provide wide ranging services beyond those needed for ASC services. These can include MRI departments, intensive care units and other advanced care facilities and services.

Because ambulatory surgery centers are focused on specific procedures, they do not need the full range of services available at a hospital. This lower overhead allows an ASC to perform certain procedures at a lower cost than what the same procedure might cost in a hospital.

But it also may limit the type of procedures available at an ambulatory surgery center. At the same time, ASCs are a practical alternative for several procedures that can be safely performed without the need for a hospital’s full range of resources and in which you don’t need to stay overnight.

Not every patient or procedure is suited for an ambulatory surgery center. You should talk with your doctor about whether an ASC or a hospital is the best location for your procedure.