Ambulatory surgery center: lower facility fee for same-day procedures
An ambulatory surgery center (ASC) is a freestanding facility for same-day surgery and endoscopy. Medicare pays the facility portion under the ASC payment system, generally below the hospital OPPS rate for the same procedure family.
Confirm your price in writing before service. Ask whether the quote is facility-only or all-in.
- Setting
- Freestanding centers focused on same-day surgery and endoscopy
- Payment system
- ASC payment system (procedure-based, generally below OPPS) + Physician Fee Schedule professional fee
- Facility fee
- Yes - ASC facility fee, typically lower than hospital OPPS for the same procedure
The endoscopist or surgeon professional fee is the Physician Fee Schedule facility amount. For example, diagnostic colonoscopy (CPT 45378) has a verified CY2026 PFS facility professional anchor of $172.49, versus a nonfacility amount of $378.46 in an office (WPS GHA, Michigan Locality 01). The ASC facility fee is separate from that professional anchor. Anesthesia and pathology, when they apply, bill as additional layers.
ASCs are built for scheduled, same-day cases. They do not carry the same standby and emergency overhead as a hospital, which is reflected in the lower facility payment. That does not automatically make every ASC quote lower than every hospital quote for every patient. It means the facility lever is worth asking about when the clinician performs the same procedure in both settings.
Ask the ASC for the all-in cash price by layer: professional, facility, anesthesia, and pathology. Ask what happens to the price if a diagnostic procedure becomes a biopsy or polyp removal on the day. Confirm the final quote in writing before service.
Procedures commonly done in surgery centers
Endoscopy and outpatient surgery codes on this site, with the surgeon or endoscopist anchor that applies in a surgery center and the hospital facility anchor for comparison. The surgery center facility fee itself is a separate ASC payment not shown here.
| Procedure | CPT | Professional anchor in a facility | Hospital OPPS facility anchor, for comparison |
|---|---|---|---|
| Colonoscopy | 45378 | $172.49 | none on record |
| Upper Endoscopy (EGD) | 43235 | $114.85 | none on record |
| Colonoscopy With Biopsy | 45380 | $185.64 | $1,222.56 (APC 5312) |
| Upper Endoscopy (EGD) With Biopsy | 43239 | $128.48 | $926.63 (APC 5301) |
| Carpal Tunnel Release | 64721 | $437.89 | $1,995.02 (APC 5431) |
| Cataract Surgery | 66984 | $467.80 | $2,357.81 (APC 5491) |
| Knee Arthroscopy (Meniscectomy) | 29881 | $539.38 | $3,342.87 (APC 5113) |
Medicare anchors verified 2026-10-18: fee schedule amounts for Michigan Locality 01, hospital amounts national unadjusted. Not cash prices. The general explanation of facility fees and the four questions that work in any setting are on the facility types overview.
Reading a surgery center quote
Surgery center cash prices are often offered as a package. The package is only comparable when it names the facility fee, the surgeon or endoscopist, anesthesia, and pathology as included or excluded, line by line.
For endoscopy the code can change on the day when a biopsy or polyp removal is performed. Ask the center for the price of each code it might bill, not only the planned one, so the written figure still holds if the procedure changes.
Questions for this setting
- Does the package include anesthesia, and is the anesthesia provider in my network?
- If a biopsy or polyp removal is done, what is the written price for that code?
- Which pathology lab receives tissue, and does it bill me directly?
- Are follow-up visits inside the surgeon's global period included? The CMS fee schedule lists a 90-day global period for the carpal tunnel, cataract and knee arthroscopy codes on this site, and 0 days for the endoscopy codes.