NAICS 621493 Quarterly Industry Report
Freestanding Ambulatory Surgical and Emergency Centers
Comprehensive industry research for valuation professionals, business owners, buyers, and lenders
NAICS Code: 621493Sector: Health Care and Social Assistance (62)Updated: Q1 2026
About This Report
This industry profile for Freestanding Ambulatory Surgical Centers (NAICS 621493) draws on data from the U.S. Census Bureau[8], Centers for Medicare and Medicaid Services[7], Bureau of Labor Statistics[9], and SBA size standards database[6]. Published by Fair Market Value and updated quarterly, it provides valuation professionals, surgical industry analysts, and healthcare investors with current market data. All quantitative claims are sourced to publicly verifiable databases.
Industry Snapshot
Key metrics for the freestanding ambulatory surgical and emergency centers industry.
NAICS Sector
62
Health Care and Social Assistance
Industry Definition & Overview
Freestanding Ambulatory Surgical Centers (NAICS 621493) encompasses freestanding ambulatory surgical and emergency centers primarily engaged in providing surgical services on an outpatient basis per the U.S. Census Bureau[5]. Ambulatory surgical centers (ASCs) perform same-day surgical procedures including gastroenterology, ophthalmology, orthopedics, pain management, and general surgery without overnight hospital admission.
Market size reached $45.7 billion in 2024 and is projected to grow to $62 billion by 2032 at a 4.1 percent compound annual rate. Procedure volumes are projected to grow 18 percent to 110 million cases by 2033 per healthcare market research data. Orthopedics dominates with 45.2 percent of ASC revenue share. United Surgical Partners International (USPI), a Tenet Healthcare subsidiary, operates as the largest ASC platform with over 500 facilities. AmSurg (Envision Healthcare), SCA Health, and NovaMed maintain additional multi-state ASC networks. Private equity firms continue deploying capital for ASC consolidation.
Per the SBA Table of Size Standards[6], the size standard is $16.5 million in average annual receipts. CMS certified 6,274 ASCs as of 2023 under 42 CFR Part 416 Conditions for Coverage, which establish surgical environment, infection control, patient rights, and quality assessment standards. CMS[7] approved a 2.9 percent payment increase for CY 2025 under the ASC Payment System. Accreditation from the Accreditation Association for Ambulatory Health Care (AAAHC) or The Joint Commission is required in most states. CMS continues adding procedures to the ASC-approved list, with total joint replacement and spine surgery migrating from hospital-only to ASC-eligible settings, driving growth in higher-acuity outpatient surgical volumes.
What's Included in This Industry
- Gastroenterology endoscopy and colonoscopy procedures
- Ophthalmology cataract and retinal surgery services
- Orthopedic arthroscopy and joint replacement surgery
- Pain management injection and spinal procedures
- General surgery including hernia repair and biopsies
- Plastic and reconstructive outpatient surgical procedures
- ENT (ear, nose, throat) surgical services
- Podiatric surgical procedures and foot surgery
- Pre-operative assessment and post-operative recovery care
- Ambulatory surgery center accreditation and compliance management
NAICS Classification Hierarchy
| Level | Description | Code |
|---|---|---|
| Sector | Health Care and Social Assistance | 62 |
| Subsector | Ambulatory Health Care Services | 621 |
| Industry Group | Outpatient Care Centers | 6214 |
| NAICS Industry | Other Outpatient Care Centers | 62149 |
| National Industry | Freestanding Ambulatory Surgical and Emergency Centers | 621493 |
Related NAICS Codes
| Code | Description | Relationship |
|---|---|---|
| 622110 | General Medical and Surgical Hospitals | General Medical and Surgical Hospitals compete with ASCs for outpatient surgical volume, with CMS procedure migration from hospital-only to ASC-eligible settings shifting cases from inpatient operating rooms to lower-cost freestanding ambulatory facilities |
| 621111 | Offices of Physicians (except Mental Health Specialists) | Offices of Physicians (General) refer patients to ASCs for outpatient surgical procedures, with many surgeons maintaining both office-based practices and ownership interests in ambulatory surgical centers where they perform procedures |
| 621512 | Diagnostic Imaging Centers | Diagnostic Imaging Centers provide pre-operative and post-operative imaging services that support ASC surgical planning, with MRI, CT, and X-ray referrals creating clinical workflow connections between imaging and surgical facilities |
| 339113 | Surgical Appliance and Supplies Manufacturing | Surgical and Medical Instrument Manufacturing supplies surgical instruments, sterilization equipment, and operating room technology to ASCs, with equipment investment representing a primary capital expenditure for facility buildout and procedure capability expansion |
| 621340 | Offices of Physical, Occupational and Speech Therapists, and Audiologists | Offices of Physical Therapists provide post-surgical rehabilitation for ASC patients, with orthopedic and spine surgery cases generating physical therapy referral volume for recovery and return-to-function treatment programs |
| 524114 | Direct Health and Medical Insurance Carriers | Direct Health and Medical Insurance Carriers negotiate ASC reimbursement rates and approve procedure coverage that determines facility economics, with payer contracting and prior authorization requirements directly influencing ASC case volume and revenue |
Geographic Concentration
Top states by share of national establishments.
| # | State | % Est. | Total Est. |
|---|---|---|---|
| 1 | California | 12.2% | 1,239 |
| 2 | Texas | 11.3% | 1,156 |
| 3 | Florida | 8.5% | 865 |
| 4 | New York | 5.0% | 514 |
| 5 | Georgia | 4.4% | 449 |
| 6 | Ohio | 3.6% | 366 |
| 7 | Arizona | 3.2% | 327 |
| 8 | New Jersey | 3.1% | 320 |
| 9 | North Carolina | 2.8% | 284 |
| 10 | Michigan | 2.7% | 272 |
% Of Establishments
0%
12%
Source: County Business Patterns, U.S. Census Bureau[3]
SBA Lending Summary
200
Total SBA Loans
$211.2M
Total Loan Volume
$1.1M
Average Loan Size
10 yrs
Average Loan Term
9.78%
Average Interest Rate
3,504
Jobs Supported
Source: SBA 7(a) Program Data, U.S. Small Business Administration — FY 2025[4]
Key Insight: Per the SBA Table of Size Standards[6], Freestanding Ambulatory Surgical Centers (NAICS 621493) has a size standard of $16.5 million in average annual receipts for federal contracting purposes. SBA lending programs[10] support facility acquisition, surgical equipment investment, and operating room buildout for qualifying ASC operators. Eligible businesses can access SBA 7(a) loans[11] for working capital, equipment, and acquisition financing, while 504 loans[12] support major fixed-asset purchases including real estate and heavy machinery.
Top SBA Lenders
| # | Lender | Loans | Volume | Avg Loan |
|---|---|---|---|---|
| 1 | Citizens Bank | 56 | $80.4M | $1.4M |
| 2 | CalPrivate Bank | 8 | $32.0M | $4.0M |
| 3 | First National Bank of Pennsylvania | 16 | $22.2M | $1.4M |
| 4 | United Community Bank | 24 | $20.4M | $852K |
| 5 | Wells Fargo Bank National Association | 8 | $16.0M | $2.0M |
Frequently Asked Questions
Common questions about this industry.
What is the NAICS code for ambulatory surgical centers?
NAICS 621493 covers freestanding ambulatory surgical centers providing same-day surgical procedures without overnight admission per the U.S. Census Bureau[5].
How large is the ASC market?
Market size reached $45.7 billion in 2024 with projections of $62 billion by 2032 at a 4.1 percent compound annual rate per healthcare market research, with procedure volumes projected to reach 110 million cases by 2033.
What is the SBA size standard for ASCs?
The SBA size standard[6] is $16.5 million in average annual receipts, determining eligibility for federal small business contracting programs and SBA lending products.
How many ASCs does CMS certify?
CMS[7] certified 6,274 ASCs as of 2023 under 42 CFR Part 416 Conditions for Coverage, with accreditation from AAAHC or The Joint Commission required in most states for operational licensure.
Which surgical specialty generates the most ASC revenue?
Orthopedics dominates with 45.2 percent of ASC revenue share per healthcare market data, with total joint replacement and spine surgery recently migrating from hospital-only to ASC-eligible settings under CMS[7] coverage rules.
Who is the largest ASC operator?
United Surgical Partners International (USPI), a Tenet Healthcare subsidiary, operates as the largest ASC platform with over 500 facilities per industry tracking data, with SCA Health and AmSurg maintaining additional multi-state networks.
What payment update did CMS approve for ASCs?
CMS[7] approved a 2.9 percent payment increase for CY 2025 under the ASC Payment System, with the approved procedure list continuing to expand as higher-acuity cases migrate from hospital outpatient departments to ambulatory settings.
Why is private equity investing in ASCs?
Private equity firms deploy capital for ASC consolidation because outpatient surgery offers lower overhead than hospital settings, growing procedure volumes from CMS list expansion, and favorable reimbursement trends per Bureau of Labor Statistics[9] industry data.
Sources & References
Government datasets and editorial sources used in this report.
- [1]U.S. Bureau of Labor Statistics, Quarterly Census of Employment and Wages bls.gov
- [2]U.S. Census Bureau, Economic Census census.gov
- [3]U.S. Census Bureau, County Business Patterns census.gov
- [4]U.S. Small Business Administration, SBA 7(a) Loan Program Data data.sba.gov
- [5]U.S. Census Bureau census.gov
- [6]SBA Table of Size Standards sba.gov
- [7]CMS cms.gov
- [8]U.S. Census Bureau data.census.gov
- [9]Bureau of Labor Statistics bls.gov
- [10]SBA lending programs sba.gov
- [11]SBA 7(a) loans sba.gov
- [12]504 loans sba.gov
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