AbstractObjectiveTo investigate the geographic clustering of ambulatory surgical center (ASC) utilization in otolaryngology to determine hot spot areas of high utilization and cold spot areas of low utilization and socioeconomic factors that correlate with these hot spots and cold spots.Study DesignTo develop a national epidemiologic study of ASC utilization in otolaryngology in the United States.SettingUnited States of America.MethodsMultiple county‐level national databases were reviewed including Center for Medicare Services (CMS) physician billing data, CMS Medicare demographic data, and US Census socioeconomic data. The analysis was conducted using the average of all Medicare billing information from 2015 to 2019. Whether a procedure was performed in an ASC was extracted from CMS data using the CMS definition of an ASC. The percentage ASC billing was calculated as the fraction of CMS payments that were performed in ASCs for the top ENT procedures. A Python‐based script for database building and GeoDa, Moran's I clustering coefficient, and a 1‐way analysis of variance was utilized to chart and analyze demographic, geographic, and socioeconomic trends.ResultsHot spots of utilization, with an average ASC billing of 80.13%, were seen in Southern California, Florida, Mid‐Atlantic, and clusters throughout the Deep South. Cold spot clusters, with an average ASC billing of 2.21%, were located in large swaths of New England, Ohio, and the Deep South with clusters bisecting the Midwest. Cold spots had a higher percentage of poverty and percent eligible for Medicaid.ConclusionASC utilization is best used to improve cost‐effectiveness and accessibility of care but what is seen is that ASC use is currently highest in cities in coastal areas which already have high levels of care access and are making the most proportional money compared to their rural counterparts.