Which states require office-based surgery accreditation, and where does AAAHC fit?

New York, California and Nevada require accreditation for office surgery with sedation or general anesthesia, Florida requires registration with accreditation in place of annual inspection, and Massachusetts is bringing office-based surgical centers under a state licence. AAAHC is an accreditor named or approved in New York, California, Florida and Massachusetts.

Why the state decides

Medicare ASCs meet the federal Conditions for Coverage in 42 CFR Part 416, and accreditation by an approved body such as AAAHC can stand in for the state survey.¹ Office-based surgery outside a Medicare ASC agreement is set by state law. Five of the states covered on these pages tie it to accreditation or a licence.

New York

Public Health Law 230-d requires private practices performing office-based surgery to be accredited by an agency the Commissioner of Health designates, and since 14 July 2009 practices have had to be accredited.² Office-based surgery means surgical or invasive procedures with general anesthesia, moderate or deep sedation, and liposuction, excluding minor procedures and minimal sedation.³ Adverse events must be reported to the Department of Health within three business days of the occurrence of the event, and an unplanned emergency department visit within 72 hours of the procedure is one of them.² AAAHC is one of three designated agencies.⁴ More on the city at clinic AI in New York City.

California

Surgery using anesthesia in doses that risk loss of the patient's life-preserving protective reflexes must take place in an accredited, licensed or certified setting. Local anesthesia and peripheral nerve blocks alone do not trigger it. Accredited settings report adverse events to the Medical Board within 5 days, or 24 hours for an ongoing urgent threat. The Board approves AAAHC as an accreditation agency.⁵ See Los Angeles and San Diego.

Florida

Offices where physicians perform Level II or Level III procedures, or liposuction removing more than 1,000 cc, must register for office surgery unless licensed under Chapter 390 or 395. The Department inspects before approving registration and annually after, unless the office is accredited by a nationally recognized agency, AAAHC among them.⁶ See Miami.

Massachusetts

Chapter 343 of the Acts of 2024 created a Department of Public Health licence for office-based surgical centers, covering procedures that need general anesthesia, moderate or deep sedation, and liposuction. It directed DPH to issue regulations by 1 October 2025, and allows a one-time provisional licence for a center accredited by AAAHC, the American Association for Accreditation of Ambulatory Surgery Facilities or the Joint Commission.⁷ Check DPH for the status of its regulations before you plan. See Boston.

Nevada

Under NRS 449.442, an office of a physician offering general anesthesia, conscious sedation or deep sedation must hold a permit for each location and maintain current accreditation by a nationally recognized organization approved by the Board, with proof within 6 months of the first permit. If accreditation lapses, the office must stop offering those services at once.⁸ See Las Vegas and Henderson.

1. Name your highest anesthesia level. It decides whether state rules apply and which case AAAHC observes.
2. Read your state's rule at source. Use the state's own page, and note the reporting deadlines.
3. Confirm the accreditor is recognised. Check AAAHC is on your state's list for your setting.
4. Allow for limits before accreditation. Where a state limits anesthesia before accreditation, AAAHC observes the highest level legally permitted.
5. Set up adverse event reporting. Write the state's deadline into your incident process, with a named reporter.
6. Prepare for the survey. Use the AAAHC survey checklist and a mock survey before the date.

1. State ______ Rule ______
2. Highest anesthesia level offered ______
3. Accreditation required, yes or no ______ Accreditor ______
4. Registration, permit or licence and renewal date ______
5. Adverse event reporting deadline ______ Reporter ______
6. Next survey ______

Copy template

Read the AAAHC accreditation hub for the CMS Conditions for Coverage, and the AAAHC mock survey guide for the procedure observation.

Questions

Does every state require office-based surgery accreditation?

No. Of the states checked here, New York, California and Nevada require accreditation for office surgery with sedation or general anesthesia, Florida requires registration with accreditation in place of annual inspection, and Massachusetts is introducing a licence.

Is AAAHC accepted for office-based surgery in New York?

Yes. AAAHC is one of three accrediting agencies designated by the Commissioner of Health, with ACHC and the Joint Commission.

Do Botox injections need office-based surgery accreditation in New York?

New York's FAQ says most procedures such as botulinum toxin injections use minimal or no sedation and can be performed in offices without OBS accreditation.

Sources

1. 1eCFR, 202642 CFR 416.26, Qualifying for an agreementRead source
2. 2New York State Department of Health, 2024Office-Based Surgery, Frequently Asked Questions for PractitionersRead source
3. 3New York State Department of Health, 2026Office-Based SurgeryRead source
4. 4New York State Department of Health, 2026NYSDOH Approved Accrediting AgenciesRead source
5. 5Medical Board of California, 2025Outpatient Surgery SettingsRead source
6. 6Florida Board of Medicine, 2026Office Surgery RegistrationRead source
7. 7General Court of Massachusetts, 2025Acts of 2024, Chapter 343, An Act enhancing the market review processRead source
8. 8Nevada Legislature, 2025NRS Chapter 449, NRS 449.435 to 449.448Read source

Written by the wai team from Accreditation Association for Ambulatory Health Care guidance, checked on 15 October 2026. This is guidance, not legal advice. AAAHC does not endorse wai or any software.