Ax-les-Thermes is situated in the Pyrénées, close to Andorra, and stands on the confluence of the Oriège, Ariège and Lauze rivers, some 75 km west of Perpignan and 35 km north-east of Andorra la Vella. Access to the commune is by Route nationale N20 from Garanou in the north-west which passes through the village then south through the commune to Mérens-les-Vals. The D613 goes north from the village to Sorgeat and the D25 branches from this to go east to Ascou and Mijanès. The railway line from Foix passes through the commune with a station just north-west of the village. The line continues south to Merens-les-Vals. Apart from the village there are the hamlets of Premiere Bazerque, Deuxieme Bazerque, Troisieme Bazerque, Petches, and Ax-Bonascre to the south. The Ax 3 Domaines Ski resort is located at Ax-Bonascre south-west of the village and is accessed by the D82 road from the village. The commune is alpine in nature with extensive forests and rugged terrain.

The Ariège river flows through the commune from south to north at the start of its journey to join the Garonne at Portet-sur-Garonne. The Ruisseau des Estagnols rises in the south of the commune and flows north to join the Ariège in the south of the commune. The Ruisseau de Risl and the Ruisseau de Font Frède both rise in the east of the commune and flow west to join the Ariège. The Oriège flows from the east to join the Ariège in the village and the Lauze flows from the east to join the Ariège just north of the confluence of the Oriège.

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