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What are Surgical Centers?
Surgical centers—more specifically, Medicare-certified ambulatory surgical centers (ASAs)—are medical facilities where patients can receive same-day surgical procedures outside of a hospital setting.
Surgical Centers vs Hospitals
The primary difference between a surgical center and a hospital is that surgical centers provide a much more narrow range of services. Surgical centers focus solely on same-day procedures that are relatively low-risk and do not require the support of a large, multi-disciplinary team.
| Surgical Centers | Hospitals | |
|---|---|---|
| Primary Care | No | Yes |
| Specialist Care | Yes | Yes |
| Emergency and Urgent Care | No | Yes |
| Overnight Stays | No | Yes |
| Same-Day Procedures | Yes | Yes |
| Costs | Costs vary depending on the care required. Often cheaper than hospitals when comparing like-for-like procedures. |
Costs vary depending on the care required. Often more expensive than surgical centers when comparing like-for-like procedures. |
| Payment Options | - Private Health Insurance - Medicare, if eligible - Medicaid, if eligible - Veterans Benefits, if eligible - Personal funds, if required |
- Private Health Insurance - Medicare, if eligible - Medicaid, if eligible - Veterans Benefits, if eligible - Personal funds, if required |
What services are provided at surgical centers?
Services at surgical centers vary. Some facilities specialize in a specific type of care—such as eye care, dermatology, or orthopedics—while others offer a broad range of medical services.
Although the type of procedures offered varies by provider, surgical centers typically provide the following:
- Same-day surgeries
- Same-day diagnostic procedures
Examples of the type of care offered at surgical centers include:
- Orthopedics (e.g. ACL repair, knee arthroscopy)
- Ophthalmology (e.g. LASIK surgery, cataract removal)
- Gastroenterology (e.g. colonoscopy, upper endoscopy)
- Dermatology (e.g. skin cancer surgeries, wart removal)
- Podiatry (e.g. bunion or ingrown toenail surgeries)
- Ear, Nose and Throat (e.g. tonsillectomy, sinus surgery)
- Pain Management (e.g. care for fibromyalgia, CRPS)
- Urology (e.g. kidney stone removal, vasectomy)
What services are not provided at surgical centers?
Ambulatory surgical centers do not provide primary health care services, urgent care services or complex medical procedures that require the patient to stay overnight. They are solely aimed at individuals who require same-day medical procedures, usually under the recommendation of a primary care or specialist physician.
How much do services at surgical centers cost and who pays for it?
By focusing on a selection of same-day procedures, ambulatory surgery centers are able to operate more efficiently and therefore be more cost-effective than hospitals in many cases. Fees vary depending the type of care needed.
People use the following methods, or most often a combination of the following methods, to pay for home health care services:
Approved procedures, facility fees and preventative services conducted at Medicare-certified surgical centers are covered by Medicare Part B. After meeting their Medicare Part B deductible, patients pay 20% of the Medicare-approved amount. Preventative services are covered in full.
Most surgical centers accept private health insurance. What you pay will depend on the type of care you require and your specific coverage (annual deductible, copays, preventative care coverage, etc.).
In most states, Medicaid covers medically-necessary procedures provided in an ambulatory surgery center for patients who meet the eligibility requirements. It may only cover specific procedures, and some procedures may require. This varies from state to state.
The Veterans Health Administration operates its own outpatient surgery centers, where veterans can receive care that is covered by their VA Health Benefits. In some cases, the VA may reimburse veterans for approved procedures at non-VA-operated surgical centers.
You may be required to pay out of pocket for certain procedures that aren’t deemed medically necessary by your health insurance provider (whether it’s private health insurance, Medicare, Medicaid or VA Benefits).
How to find the best surgical centers for you and your loved ones.
Ask your doctor. Some insurance plans and some surgical centers may require you to have a referral from your physician in order to receive certain procedures. Even if this isn’t the case, it may still be helpful to ask your doctor which facilities he or she would recommend.
Find a surgical center that specializes in the care you need. Every surgical center offers a different set of services. Make sure they are able to perform the procedure you need and, if possible, choose a center that specializes solely in that area of medicine.
Make sure the surgical center is Medicare-certified. Even if you aren’t a Medicare beneficiary, choosing a Medicare-certified center ensures that the facility meets Medicare’s quality requirements and is reviewed on a regular basis.
Check to see if the surgical center is licensed by the state. Most states require ACAs to meet specific requirements in order to get a state license. Enquire with your state’s Department of Health for more information.
Find surgical centers near you. Look for facilities located close to where you live so that you can get home quickly, rest and recuperate following your visit.
Review costs and coverage upfront. As is often the case with healthcare, costs and billing at surgical centers can be complex. The facility should be willing to work with you to explain the costs involved and how your insurance will be billed.
