Item 1.01 - Entry into a Material Definitive Agreement

On December 1, 2008, NovaMed, Inc. (the "Company") entered into a Fourth Amendment and Consent to Credit Agreement (the "Fourth Amendment") with National City Bank, as agent and lender, Bank of America, N.A., as successor by merger to LaSalle Bank National Association, as documentation agent and lender, and The Northern Trust Company, Associated Bank, N.A., RBS Citizens, N.A., JPMorgan Chase Bank, National Association, and BMO Capital Markets Financing, Inc., as the other participating lenders. The Fourth Amendment amended the terms of the Sixth Amended and Restated Credit Agreement dated as of February 7, 2007, as amended (the "Credit Facility"), among the same parties to the Fourth Amendment. Under the terms of the Credit Facility, the Company's subsidiaries are limited in their ability to procure bank financing outside of the Credit Facility. The Fourth Amendment sets forth the lenders' consent to the assumption of certain debt of one or more ambulatory surgery centers to be acquired by the Company or its wholly owned subsidiaries, provided the aggregate amount of such debt does not exceed $6,000,000.

The foregoing summary does not purport to be complete and is qualified in its entirety by reference to the full text of the Fourth Amendment, which is filed herewith as Exhibit 10.25 and is incorporated herein by reference.

Item 9.01 Financial Statements and Exhibits

(d) Exhibits

Exhibit Number Title

10.25 Fourth Amendment and Consent to Credit Agreement dated as of December 1, 2008, by and among NovaMed, Inc., National City Bank, as agent, and the other lenders thereto

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