Image by Urban Origami from PixabayNot all growth in the ambulatory surgery center (ASC) industry is created equal.
While the overall ASC market continues to expand, new data show that a handful of specialties are driving most of the momentum. Others, in contrast, are somewhat contracting.
Since 2017, the number of centers offering pain management surgery has climbed 51.7%, while endoscopy has grown 46.7%, according to ASC Data’s Q4 2025 Insights Report, released Feb. 5. Similarly, orthopedic surgery centers have increased 18.4% over the same period.
On the other end of the spectrum, OBGYN-focused ASCs have declined 7.9% since 2017, and plastic surgery centers have declined by 0.8%. Growth in ophthalmology and podiatry has also been modest, at 3.1% and 2%, respectively.
ASC Data’s report draws its insights from 6,566 Medicare-certified ASCs across the U.S.
Contextually, specialties such as pain and endoscopy tend to offer predictable case volumes, favorable reimbursement profiles and relatively standardized workflows.
Pain surgery is now offered in 2,371 Medicare-certified ASCs, while endoscopy is available in 2,081 centers, according to ASC Data. Orthopedics, long considered a cornerstone of ASC growth, remains prevalent at 2,376 centers and continues to expand, though at a slower pace than pain or gastrointestinal procedures.
The data suggest that operators are gravitating toward service lines with durable demand and repeat utilization. An aging population, with an estimated 10,000 baby boomers turning 65 each day, is likely to reinforce demand for musculoskeletal and gastrointestinal care in outpatient settings.
At the same time, specialties facing reimbursement pressure or higher operational complexity appear to be losing ground. The decline in OBGYN participation reflects broader shifts in where certain procedures are performed, as well as persistent liability and payer dynamics that can complicate outpatient economics.
Plastic surgery’s slight contraction may signal market saturation in some regions or a rebalancing toward hospital outpatient departments for certain reconstructive cases.
Just over half of Medicare-certified ASCs operate as single-specialty centers. Among those, endoscopy accounts for 26% of single-specialty facilities, making it the most common focused model, followed closely by ophthalmology at 25%.
Multi-specialty centers, meanwhile, increasingly revolve around combinations anchored by orthopedics and pain. The most common three-specialty mix includes orthopedic, pain and podiatric services, reflecting a musculoskeletal-heavy orientation that allows centers to capture a broader range of procedures while sharing equipment, staff and other resources.
ASC News has previously reported that expansion strategies in 2026 are often centered on increasing acuity or deepening presence in core specialties, rather than branching into entirely new clinical areas.
