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Navigating Code Jurisdiction for Your California Ambulatory Surgery Center

Wading through California real estate was tricky enough, but now that you've chosen the perfect location for your Ambulatory Surgery Center and closed the deal, you are confronted by a whole new challenge: California's many code compliance entities. Because it's not simply following the requirements, it's determining whose requirements you are supposed to follow. CBC? CDPH? HCAI? NFPA? Local? It's enough to make your head spin!

But take heart with this fact: you are not alone! We're here to help you make sense of it all so you can focus on your patients and your practice.


The first hurdle to jump is determining whether you need to get HCAI involved in your building plans. The Department of Healthcare Access and Information (HCAI, formerly OSHPD) only wants to get involved in buildings that are intended to be licensed by the California Department of Public Health (CDPH).

While Surgical Clinics require California State licensure, not all Surgery Centers do. From CDPH, a surgical clinic (known as a SURGC) is defined as "a clinic that is not part of a hospital and that provides ambulatory surgical care for patients who remain less than 24 hours. A surgical clinic does not include any place or establishment owned or leased and operated as a clinic or office by one or more physicians or dentists in individual or group practice, regardless of the name used publicly to identify the place or establishment... physicians or dentists may, at their option apply for licensure" (Health and Safety Code (HSC) section 1204(b)(1)).

For those that fall under SURGC class, or those who wish to apply for licensure with CDPH, an OSHPD-3 certification is required. The Owner may elect to go through a full HCAI review or a local-only review for OSHPD-3, Title-24 and finally a CDPH survey that follows NFPA 101 (more on this later).

But for Physicians and dentists for whom licensure is not required, OHPD-3 is excluded and we can bypass at least *some* of the red tape.


In the State of California, "if an Ambulatory Surgery Center (ASC) is performing a procedure that requires sedation, then the facility needs to be Medicare certified, licensed by CDPH or nationally accredited" (California Ambulatory Surgery Association ((CASA)).

A nationally accredited Ambulatory Surgery Center that is neither licensed by CDPH nor certified for Medicare must follow CBC, local permitting and Title-24. If fewer than five patients are incapacitated at once, this would be considered a Doctor's Office and would fall under Business Occupancy. If five or more patients are incapacitated at once, including pre-op and post-op/recovery, CBC requires that I-2.1 Occupancy -- or Institutional Occupancy -- be followed.

But for many physicians, being Medicare-certified is a make-or-break deal. For Ambulatory Surgery Centers to be certified for Medicare, in addition to CBC, local permitting and Title-24, CDPH must conduct a survey to ensure that the center complies with the National Fire Protection Association (NFPA) 101: Life Safety Code, and specifically that of the Ambulatory Healthcare Occupancy level. These regulations are extensive, requiring items such as emergency power, fire-rated separation between the ASC and any adjoining spaces, smoke barriers, fire sprinklers, and automatic fire alarm system, among other requirements.

If your practice does not require use of sedation, and your ASC utilizes only local anesthesia, peripheral nerve blocks, or lower-dose anxiolytic and analgesics, the ASC will only be required to comply with NFPA 101 at a lower Business Occupancy level, eliminating many of the regulations listed above.


To summarize the above, we can state the following:

  • Surgical Clinics (SURGC class) require California state licensure (CDPH), OSHPD-3, Title-24, NFPA 101: Life Safety Code. The Owner may elect to go through HCAI or through local channels for the OSHPD-3 and Title-24 requirements.

  • Physician-owned ASCs do not fall into this category, and does not require licensure with CDPH, which removes OSHPD-3 requirements.

  • Physician-owned ASCs not seeking Medicare certification must follow CBC and Title-24, with their CBC-Occupancy levels determined by the number of incapacitated patients at any given time.

  • Physician-owned ASCs seeking Medicare certification where procedures requiring sedation are performed require CBC, Title-24 as well as NFPA 101: Life Safety Code at the more stringent Ambulatory Healthcare Occupancy level.

  • Physician-owned ASCs seeking Medicare certification where procedures requiring sedation are not performed require CBC, Title-24 and the NFPA 101: Life Safety Code at the more lenient Business Occupancy level.

The Farnsworth Group has helped many Ambulatory Surgery Centers in Southern California navigate the labyrinth of code requirements for their new building. Now we are ready to work with you, whether it's a ground-up project or renovation of an existing space. Let us work together to create the practice you've always wanted by designing the office of your dreams.


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