M&A activity snapshot
ASCs are a large, physician-partnered market that national operators have been buying for years. In 2024, about 6,400 ASCs treated 3.4 million fee-for-service (FFS) Medicare beneficiaries, and FFS Medicare program and beneficiary spending on ASC services was about $7.5 billion in 2024. MedPAC reports the number of ASCs nationwide grew over 2 percent per year, on average, between 2019 and 2024.
Counts differ by source and scope. VMG Health puts Medicare-certified ASCs at 6,468 facilities by 2025, and it estimates about 65% of freestanding ASCs remain independently owned. That independent base is the pool consolidators draw from.
The market is concentrated in a few specialties. About 68 percent of ASCs that billed FFS Medicare in 2024 specialized in a single clinical area, with gastroenterology and ophthalmology the most common. MedPAC also notes over 95 percent of ASCs are for profit.
The largest deal of the past year was a health system buying a national operator. Ascension closed its $3.9 billion acquisition of ambulatory surgery provider AmSurg in June 2026. The FTC required it to divest seven AmSurg facilities in overlapping markets, a sign that antitrust review now reaches surgery-center portfolios.
Who is buying
National operators lead the category. Tenet's USPI had interests in 533 ASCs, 401 of which were consolidated, along with 26 surgical hospitals at the end of 2025. Much of that came through roll-ups, including a $1.1 billion acquisition of SurgCenter Development that added an ownership stake in 86 more surgery centers.
Payer-owned operators are the second group. Optum entered the ASC market in 2017 when it paid about $2.3 billion for Surgical Care Affiliates, then a chain with 205 surgical facilities. SCA Health now cites 340+ ASCs and says 9,700+ physicians perform surgeries at SCA Health facilities. In January 2025 it acquired U.S. Digestive Health, adding 24 endoscopy ASCs.
Surgery Partners is the remaining public pure-play. In 2025 it rejected a take-private offer from its largest shareholder, Bain Capital. Private equity is also building specialty platforms: Welsh, Carson, Anderson & Stowe made a strategic growth investment in Constitution Surgery Alliance, a developer and operator with 16 facilities.
What buyers look for
Buyers price an ASC on its physicians first. Advisers quoted by ASC News list physician ownership levels and age mix, location quality, payer mix, and the integrity of the group's operations and financials as the traits that push multiples up. Centers with compliance gaps, aging infrastructure or revenue cycle problems face valuation challenges.
Case mix is the second lens. Buyers want specialties CMS is moving out of the hospital. For CY 2020, CMS added Total Knee Arthroplasty to the ASC covered procedures list. For 2026, CMS added 560 surgical procedures and 35 ancillary services and set the inpatient-only list to be eliminated in its entirety over a three-year period ending Jan. 1, 2028.
Payer and pricing exposure is the third. Medicare pays ASCs less than hospitals: the ASC conversion factor ($56.32 in 2026) is less than the factor used in the OPPS ($90.97 in 2026). Commercial rates matter more. A Health Affairs study found prices at Optum-acquired centers rose an average of 11% for other private insurers, which is the kind of finding that draws payer and regulator attention.
What makes a strong company
ASCs that draw competitive interest tend to share these traits:
- A stable group of owner-surgeons with a mix of ages, so case volume does not depend on a few physicians near retirement.
- A specialty mix that includes procedures CMS keeps adding to the ASC list, such as orthopedics and total joints.
- A commercial payer mix with in-network contracts, not heavy reliance on Medicare rates or out-of-network billing.
- Clean revenue cycle performance and a current life-safety and accreditation record.
- In certificate-of-need states, a license that would be hard to replicate. North Carolina, for example, now exempts some new ASCs located in a county with more than 125,000 people, which erodes that barrier there.
Valuation and deal structure
Single-center multiples are mid-to-high single digits. The median total invested capital-to-EBITDA multiple for ASC transactions ticked up to 7.9 times in 2025, the highest level in at least eight years. The same report notes that Tenet has highlighted an average initial acquisition multiple of 8-10 times for its USPI ownership interest, while Surgery Partners cites effective multiples under 8 times adjusted EBITDA.
Most ASC deals are partial sales, not full exits. Operators typically buy a controlling or minority stake and keep surgeons as co-owners. Surgery Partners describes a base of over 100 employed, 1,000 partnered and 5,000 affiliated physicians. Tenet's SurgCenter Development deal included a commitment to buy additional interests of up to $250 million from physician owners.
Physician ownership is shaped by federal fraud-and-abuse rules and state law. The structure of any syndication, buy-in price, or referral pattern is a legal question for counsel, not a market data point. This page does not cite a source for safe-harbor thresholds, and owners should not treat any figure here as advice.
Outlook
Policy keeps pushing volume toward ASCs. CMS finalized a 2.6 percent update to ASC payment rates for 2026 and is removing 285 mostly musculoskeletal procedures from the inpatient-only list in the first step. MedPAC also continues to flag that Medicare does not require ASCs to submit cost data, a possible future reporting burden.
Expect the buyer pool to stay wide over the next 12-24 months, with health systems, payer-owned operators, and PE platforms all active. The FTC divestiture order in the AmSurg deal suggests larger portfolio deals will face more market-by-market review. For a single center, multiples near the 7.9x median depend on physician alignment and case mix more than on headline market growth.
Own a surgery center and want a baseline before you talk to an operator? Run the valuation tool. Back to Healthcare Services M&A. See also: how buy-side mandates feed PE pipelines.