Valuing Ambulatory Surgery Centers in 2025: A Comprehensive Guide for Surgeons, Investors, and M&A Professionals

The ambulatory surgery center (ASC) industry has experienced steady growth driven by the shift of procedures from inpatient hospitals to lower-cost outpatient settings, supported by advancements in minimally invasive surgical techniques and favorable reimbursement trends. In the M&A landscape, ASCs are highly attractive to private equity firms and strategic healthcare buyers due to their scalable business models, high margins, and potential for consolidating fragmented markets. Valuations in this sector are often influenced by procedure mix, physician alignment, and payer relationships, with larger multi-site platforms commanding premium EBITDA multiples compared to standalone centers.

Whether you're preparing to sell a controlling or minority interest in an ASC or a portfolio of centers, evaluating a partnership opportunity, or seeking to benchmark financial performance, this article explores the key valuation methodologies, drivers, and risk factors that determine the value of an ASC.

I. Industry Context: Why Ambulatory Surgery Centers are in Demand

The ASC industry has experienced significant growth over the past decade, driven by the shift toward outpatient care, advancements in minimally invasive surgical techniques, and cost-efficiency benefits for both patients and payers. ASCs specialize in providing same-day surgical care, including diagnostic and preventive procedures, across a wide range of specialties such as orthopedics, ophthalmology, urology, neurosurgery, gastroenterology, otolaryngology, and pain management. These facilities are increasingly attractive to healthcare providers and investors due to their ability to deliver high-quality care at a lower cost compared to traditional hospital settings, often resulting in significantly higher profit margins despite lower reimbursement rates. The industry’s growth is further supported by favorable regulatory changes, such as the expansion of Medicare-covered procedures eligible for ASC settings, and the increasing demand for convenient, patient-centered care.

Key Growth Drivers

Key growth drivers for the industry include the following:

• Cost Efficiency: ASCs offer a more cost-effective alternative to hospital-based outpatient surgeries. The lower overhead costs, streamlined operations, and efficient use of resources result in significant savings for both patients and payers, making ASCs an attractive option for many surgical procedures.

  
  

• Advancements in Medical Technology: Technological advancements in minimally invasive surgical techniques, anesthesia, and pain management have expanded the range of procedures that can be safely and effectively performed in ASCs. These innovations reduce recovery times and enhance patient outcomes, further driving the demand for ASC services.

  
  

• Favorable Regulatory Environment: Regulatory changes and government policies that promote outpatient care and value-based healthcare models have encouraged the growth of ASCs. Initiatives such as the Medicare Ambulatory Surgical Center Payment System and the removal of certain procedures from the inpatient-only list have facilitated the expansion of ASCs.

  
  

• Patient Preference for Convenience and Comfort: Patients increasingly prefer ASCs due to the convenience, shorter wait times, and more personalized care they offer compared to hospitals. The comfortable, patient-centered environment of ASCs enhances the overall patient experience, contributing to their growing popularity.

  
  

• Shift Toward Outpatient Care: There is a broader trend in the healthcare industry toward outpatient care, driven by the need to reduce healthcare costs and improve efficiency. As more procedures are deemed safe for outpatient settings, the demand for ASCs continues to rise, supported by evidence of comparable or better outcomes for many surgeries performed in ASCs.

  
  

• Demographic Trends and Aging Population: The aging population, particularly the baby boomer generation, is driving demand for surgical procedures, many of which can now be performed in ASCs. As this demographic continues to age, the need for cost-effective, efficient surgical care will further fuel the growth of the ASC market.

Reimbursement Outlook

In 2025, Medicare will deliver a 2.9% increase to the ASC fee schedule for centers meeting quality reporting requirements, driven by inflation adjustments and productivity factors—providing modest relief amid rising operational costs. Although this update improves baseline reimbursement, private commercial payers remain cautious, with pricing largely flat due to broader medical cost pressure and utilization management practices. Looking ahead to 2026, CMS is proposing a 2.4% payment rate increase for both ASCs and Hospital Outpatient Departments (HOPDs) that report quality metrics, and plans to expand the ASC Covered Procedures List by over 500 codes, offering potential volume growth from new procedural opportunities.

II. Top Reasons to Get a Valuation of Your Surgery Center

The following is a list of common reasons for commissioning a valuation analysis or appraisal of an ambulatory surgery center:

1. Preparing for a Sale or Strategic Partnership

• To establish a defensible asking price when marketing the business

• To evaluate offers from private equity, strategic buyers, or joint venture partners

• To understand how your center compares to market benchmarks

  
  

2. Internal Ownership Transition

• For buy-in or buy-out of partners

• To support fair and compliant equity allocation among physician-owners

• To plan for generational succession or family transfers

3. Compliance with Healthcare Regulations

• To support Fair Market Value (FMV) and Commercial Reasonableness (CR) assessments required by Stark Law and Anti-Kickback Statute in deals involving ownership by other healthcare providers

• To document compliance in joint ventures, especially when there is a referral relationships (hospitals, ancillary service providers, or other physicians)

  
  

4. Estate & Tax Planning

• For gift or estate tax reporting to the IRS (especially for closely held businesses)

• To support asset protection strategies

• To plan for long-term wealth transfer or charitable contributions

  
  

5. Litigation or Dispute Resolution

• For divorce proceedings involving business asset division

• In shareholder or partnership disputes

• For economic damages assessments in legal proceedings

  
  

6. Business Planning & Strategic Growth

• To establish a valuation baseline for performance benchmarking

• To support capital raise, refinancing, or line-of-credit applications

• To identify value drivers and areas for operational improvement

III. Valuation Approaches for Ambulatory Surgery Centers

Valuation professionals typically apply three core methodologies to estimate the value of an ASC:

Income Approach (Discounted Cash Flow or Capitalization of Earnings)

This approach values a business based on the present value of its expected future earnings or cash flows. It’s most appropriate when a center has a stable operating history and predictable future performance.

Key assumptions include:

• Normalized EBITDA or owner’s discretionary earnings

• Growth rate assumptions (organic and acquisitive)

• Risk-adjusted discount rate (typically 10–20% for surgery centers)

• Capital expenditure needs

Pros: Based on the business’ future earning power

Cons: Sensitive to forecasting errors and discount rate subjectivity

Market Approach (Comparable Transaction Method, e.g. Market Multiples)

This method uses observed EBITDA multiples or revenue multiples from recent M&A transactions or public companies in the ambulatory surgery center space. Typical multiples for ASCs are within the range of 5x to 9x EBITDA, depending on a wide variety of factors.

This article includes more details and information about ambulatory surgery valuation multiples.

Pros: Easy to benchmark; useful in active M&A environments

Cons: Requires access to quality private market data and careful adjustment for center size, margin, geography, and a variety of other factors

Asset-Based Approach

Used only when the business is underperforming or being liquidated. The value is derived from the net assets (e.g., equipment, leasehold improvements) minus liabilities.

Pros: Useful in distressed scenarios

Cons: Intangible value of the center can be difficult to quantify under this method

IV. Key Value Drivers in ASC Valuation

Several specific factors can materially influence a surgery center's valuation multiple:

Earnings Quality

Buyers and valuation professionals place significant emphasis on normalized EBITDA and / or cash flow. Adjustments often include:

• Owner compensation (if above/below market)

• Non-recurring revenue or expenses

• Related-party lease arrangements

• Post-transaction adjustments

• Out-of-period adjustments

Growth Potential

Discount rates and valuation multiples are a function of perceived risk and growth. Key considerations within the industry related to growth include the following:

• High-Demand Specialty Mix: Offering high-reimbursement procedures in specialties like orthopedics, spine, ENT, ophthalmology, and GI boosts profitability and attracts both patients and referring providers.

  
  

• Capacity for Provider and Procedure Expansion: Available OR time, extended hours, or the ability to add new surgeons and service lines (e.g., robotics, total joints) suggests room for organic growth.

  
  

• Strong Payer and Referral Relationships: In-network contracts with commercial insurers and a diversified referral base reduce reimbursement volatility and ensure a consistent patient pipeline.

Risk Factors

Key considerations within the industry related to risk include the following:

• Strong Physician Alignment and Case Volume Stability: Long-standing relationships with high-performing surgeons (especially those with ownership stakes) ensure consistent procedure volume and reduce referral uncertainty.

  
  

• Diverse and Favorable Payer Mix: A healthy balance of commercial, Medicare, and self-pay patients, along with in-network contracts, reduces reimbursement risk and revenue volatility.

  
  

• High-Quality Clinical Outcomes and Accreditation: Accreditation by recognized bodies (e.g., AAAHC or Joint Commission) and strong patient safety records signal compliance, quality care, and reduced legal risk.

  
  

• Operational Efficiency and Scalable Infrastructure: Standardized protocols, optimized scheduling, and efficient staffing models support strong EBITDA margins and scalability, lowering integration risk.

  
  

• Modern Facility with Up-to-Date Equipment: Well-maintained physical infrastructure and current surgical equipment reduce capital expenditure needs and support ongoing clinical excellence.

V. Current Market Trends in Surgery Center M&A

From an M&A perspective, the ASC sector is highly fragmented, presenting numerous opportunities for consolidation and strategic partnerships. Private equity firms, hospital systems, and physician groups are actively acquiring and developing ASCs to capitalize on the sector’s strong financial performance and alignment with value-based care models. Key drivers of M&A activity include the pursuit of scale, geographic expansion, and the integration of ancillary services to enhance revenue streams. However, successful transactions require careful consideration of regulatory compliance, physician alignment, and operational efficiency to maximize returns. As healthcare continues to evolve, ASCs are poised to play a pivotal role in the delivery of cost-effective, high-quality care, making them a compelling focus for investment and strategic growth initiatives.

The number of announced ambulatory surgery center M&A deals has fluctuated in recent years, without a declining trend. Much of the M&A activity in the segment is dominated by hospitals, physician groups, and joint venture entities - where public announcements are infrequent.

Impact of Size on Ambulatory Surgery Center EBITDA Multiples

To better illustrate the impact of size on ASC valuations, we looked at historical comparable transaction data from the Scope Research Healthcare M&A Valuation Database and compared the size of the acquired company in terms of EBITDA to the implied multiple from the transaction.

VI. Final Thoughts: Keys to Maximizing Value

• If you're an ASC lead physician-partner or administrator helping to explore a sale or equity partnership, consider the following strategies to enhance your valuation:

  
  

  • Optimize Case Mix Toward High-Reimbursement Procedures: Focus on higher-margin specialties like orthopedics, spine, GI, and ophthalmology to drive profitability, while maintaining a balanced payer mix that includes commercial insurers.

    
    

  • Ensure Strong Physician Alignment and Ownership Structure: Maintain active engagement and buy-in from high-performing surgeons through ownership incentives or governance roles, as their case volume is critical to revenue.

    
    

  • Maximize Operational Efficiency and Capacity Utilization: Improve scheduling, turnover times, and staffing efficiency to increase throughput and EBITDA margins—key metrics for buyers evaluating ASC performance.

    
    

  • Maintain Regulatory Compliance and Accreditation: Ensure the ASC is fully accredited (e.g., AAAHC, Joint Commission) and in compliance with CMS and state regulations, reducing risk and increasing buyer confidence.

    
    

  • Professionalize Financials: Buyers prefer accrual-based, GAAP-compliant statements.

  
  

  About HealthFMV

  HealthFMV specializes in appraising healthcare businesses and services arrangements, including ambulatory surgery centers.

  
  

  • Business Valuation: We perform independent, third-party valuations of healthcare businesses to document regulatory, tax, and financial reporting compliance, resolve ownership disputes, and help ensure both parties to the transaction are comfortable with the financial terms.

    
    

  • Transaction Advisory: We work with healthcare business owners, organization executives, providers, and their health lawyers to develop transaction structures and deal terms that further their business objectives while maintaining compliance with the complex healthcare regulatory environment.

    
    

  • Services Arrangements: We prepare fair market value and commercial reasonableness opinions for a variety of healthcare services arrangements including management services, hospital-based specialty stipends, case rates and PC/TC splits, block leasing, and shared savings distributions, among others.

  
  

  Contact Will Hamilton at whamilton@healthfmv.com with questions about our healthcare valuation services or to discuss your specific situation. Visit scoperesearch.co for more information about our healthcare M&A research services.