To participate in the Medicare program, an Ambulatory Surgery Center (ASC) must be certified and approved to enter into a written agreement with the Centers for Medicare & Medicaid Services (CMS). An ASC must operate exclusively to provide surgical services to patients who do not require hospitalization, with services typically completed within 24 hours of admission. While rare, unanticipated medical situations may occasionally necessitate a patient staying beyond 24 hours.
Regulations strictly define an ASC as a distinct entity. It cannot share space or operate concurrently with another entity, such as a physician’s office, within a common area. However, CMS does allow two separately certified ASCs to share the same physical space—as long as their operations are entirely distinct and do not overlap in time. This includes separate staffing, records, and operational hours.
Importantly, ASCs are not permitted to share space, even temporally, with hospitals, Critical Access Hospital outpatient surgery departments, or Medicare-participating Independent Diagnostic Testing Facilities (IDTFs). While ASCs may provide certain radiology services integral to covered surgical procedures, they do not need to be separately certified as an IDTF for these services to be reimbursed under Medicare.

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