Objective: Trans-arterial chemoembolization (TACE) is the recommended treatment for intermediate-stage hepatocellular carcinoma (HCC) according to American Association for the Study of Liver Disease (AASLD) guidelines. In an era of healthcare regionalization, it is unclear whether hospital volume is associated with post-TACE outcomes. Methods: The 2012 linkage of Surveillance, Epidemiology, and End Results (SEER)-Medicare database was utilized. A multivariable Cox proportional hazards model was utilized to evaluate the association between post-TACE survival and patient factors, hospital characteristics, and TACE volume. Results: 4258 patients with HCC treated with TACE comprised the study cohort. The mean age was 70, patients were 69.7% male, 60.6% Caucasian, 58.8% had HCV, 40.0% had multifocal disease, and median tumor size was 4.5 cm. Teaching hospitals, large hospitals and hospital performing >100 TACE treated 59.0%, 47.5%, and 35.8% of patients respectively. Median survival was 24.5 months. Unadjusted KM survival analysis demonstrated improved survival in hospitals performing >100 TACE annually (p < 0.001, figure). After controlling for sociodemographic, oncologic, and hospital characteristics, there was no significant association with TACE volume and survival. Significant survival predictors were household income, HBV status, extrahepatic disease, Charlson score, tumor size, AJCC stage, concordance with AASLD guidelines, and receiving additional oncologic treatments. Conclusion: Neither hospital size, teaching status, nor TACE volume predicted survival in the Medicare patient population. These data encourage widespread utilization of TACE.