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As medical technology advances and guidelines for routine inpatient surgeries are relaxed, physicians are able to perform a greater number of procedures in an outpatient setting.  

This is generally beneficial for patients, as costs at an ambulatory surgery center (ASC) are lower on average than at a hospital or other inpatient facility. While most hospitals offer outpatient surgery, ASCs have been praised as a superior choice for certain procedures.  This preference is due to facility efficiencies and greater regulatory controls for reimbursements under the outpatient prospective payment system. 

Definitive Healthcare tracks nearly 3,000 procedure types performed at over 9,000 ASCs. The following lists rank the top 25 procedures performed at surgery centers by total charges as well as procedure volume.  

Topping the list is Extracapsular cataract removal, CPT code 66984, followed by an injection of onabotulinumtoxinA, HCPCSs code J0585, with nearly 900,000 procedures. OnabotulinumtoxinA is an injectable neurotoxin, better known under brand names such as Botox and Botox Cosmetics. 

Both lists of procedures are dominated by diagnostic procedures such as colonoscopies and esophagogastroduodenoscopies with biopsies. Cataracts surgeries also topped both lists, with more than 1.2 million procedures reported in 2018 (most recent data available). Spinal injections were also common, including joint denervations.  

Top 25 Most Performed Procedures at Ambulatory Surgery Centers

Rank HCPCS/CPT Code HCPCS Description Number of Procedures Total Charges

1.

66984 EXTRACAPSULAR CATARACT REMOVAL W/ INSERTION OF IO LENS PROSTHESIS W/O ENDOSCOPIC CYCLOPHOTOCOAGULATION 1,251,164 $1,203,836,786

2.

J0585

INJECTION, ONABOTULINUMTOXINA

894,793 $5,462,609

3.

43239 EGD BIOPSY SINGLE/MULTIPLE 527,817 $166,052,761

4.

45380 COLONOSCOPY AND BIOPSY 459,209 $187,755,470

5.

45385 COLONOSCOPY W/LESION REMOVAL 409,019 $196,440,448

6.

64483 INJ FORAMEN EPIDURAL L/S 315,173 $98,275,396

7.

66821 AFTER CATARACT LASER SURGERY 279,440 $67,857,702

8.

64493 INJ PARAVERT F JNT L/S 1 LEV 226,368 $64,234,232

9.

62323 NJX INTERLAMINAR LMBR/SAC 184,148 $50,642,428

10.

G0105

 

COLORECTAL SCRN; HI RISK IND

138,269 $47,348,253

11.

45378 DIAGNOSTIC COLONOSCOPY 115,168 $36,627,045

12.

64635 DESTROY LUMB/SAC FACET JNT 112,369 $79,517,957

13.

G0121 COLON CA SCRN NOT HI RSK IND 111,684 $38,509,195

14.

J3300 TRIAMCINOLONE A INJ PRS-FREE 109,465 $419,165

15.

G0260 INJ FOR SACROILIAC JT ANESTH 95,144 $22,245,165

16.

66982 COMPLEX REMOVAL OF CATARACT WITH INSERTION OF LENS 91,686 $88,594,583

17.

52000 CYSTOSCOPY 82,909 $23,479,992

18.

64490 INJ PARAVERT F JNT C/T 1 LEV 75,257 $21,967,363

19.

62321 NJX INTERLAMINAR CRV/THRC 65,815 $18,197,660

20.

15823 REVISION OF UPPER EYELID 59,700 $36,619,604

21.

43235 EGD DIAGNOSTIC BRUSH WASH 59,512 $19,254,754

22.

43248 EGD GUIDE WIRE INSERTION 50,542 $17,342,958

23.

64721 CARPAL TUNNEL SURGERY 48,889 $36,582,656

24.

26055 INCISE FINGER TENDON SHEATH 43,294 $24,982,443

25.

J7328

GELSYN-3 INJECTION 0.1 MG

42,349 $91,989

Fig 1. Data from Surgery Centers database based on 2018 Medicare Ambulatory Surgery Center Limited Data Set. Calendar year data is projected to be released each January by the CMS. The most recent data is from calendar year 2018; 2019 data is scheduled to be released in January 2021. Accessed May 2020.

 

The following list details the top 25 procedures performed at ASCs by total charges. Extracapsular cataract removal, CPT code 66984, had the highest total charges, followed by the insertion or replacement of spinal neurostimulator pulse generator, CPT code 63685, with $259.3 million in total charges. 

Top 25 Procedures Performed at Surgery Centers by Total Charges

Rank HCPCS/CPT Code HCPCS Description Number of Procedures Total Charges

1.

66984 EXTRACAPSULAR CATARACT REMOVAL W/ INSERTION OF IO LENS PROSTHESIS W/O ENDOSCOPIC CYCLOPHOTOCOAGULATION 1,251,164 $1,203,836,786

2.

63685 INSRT/REDO SPINE N GENERATOR 11,325 $259,397,185

3.

45385 COLONOSCOPY W/LESION REMOVAL 409,019 $196,440,448

4.

45380 COLONOSCOPY AND BIOPSY 459,209 $187,755,470

5.

63650 IMPLANT NEUROELECTRODES 40,151 $185,590,750

6.

43239 EGD BIOPSY SINGLE/MULTIPLE 527,817 $166,052,761

7.

64483 INJ FORAMEN EPIDURAL L/S 315,173 $98,275,396

8.

0191T INSERT ANT SEGMENT DRAIN INT 36,510 $94,373,543

9.

66982 COMPLEX REMOVAL OF CATARACT WITH INSERTION OF LENS 91,686 $88,594,583

10.

64635 DESTROY LUMB/SAC FACET JNT 112,369 $79,517,957

11.

66821 AFTER CATARACT LASER SURGERY 279,440 $67,857,702

12.

64493 INJ PARAVERT F JNT L/S 1 LEV 226,368 $64,234,232

13.

29827 ARTHROSCOP ROTATOR CUFF REPR 25,897 $63,564,800

14.

64590 INSRT/REDO PN/GASTR STIMUL 3,246 $51,779,518

15.

62323 NJX INTERLAMINAR LMBR/SAC 184,148 $50,642,428

16.

36902 INTRO CATH DIALYSIS CIRCUIT 18,446 $47,501,204

17.

G0105 COLORECTAL SCRN; HI RISK IND 138,269 $47,348,253

18.

C9740

CYSTO IMPL 4 OR MORE

6,628 $41,130,006

19.

G0121

COLON CA SCRN NOT HI RSK IND

111,684 $38,509,195

20.

V2785 CORNEAL TISSUE PROCESSING 9,630 $37,718,222

21.

45378 DIAGNOSTIC COLONOSCOPY 115,168 $36,627,045

22.

15823 REVISION OF UPPER EYELID 59,700 $36,619,604

23.

64721 CARPAL TUNNEL SURGERY 48,889 $36,582,656

24.

22869

INSJ STABLJ DEV W/O DCMPRN

2,649 $32,414,982

25.

29881 KNEE ARTHROSCOPY/SURGERY 23,628 $29,793,651

Fig 2. Data from Surgery Centers database based on 2018 Medicare Ambulatory Surgery Center Limited Data Set. Calendar year data is projected to be released each January by the CMS. The most recent data is from calendar year 2018; 2019 data is scheduled to be released in January 2021. Accessed May 2020.