1. (1)       Patients must be individually evaluated using objective and subjective criteria for each procedure to determine if the physician office is an appropriate setting for the anesthesia required and for the surgical procedure to be performed. Patient selection shall occur pursuant to procedure-specific written criteria which shall be available for inspection by the Board and shall comply with any requirements issued by the physician office’s credentialing entity. These criteria shall include both inclusionary and exclusionary criteria.
2. (2)       Patients undergoing Level II or Level III office-based surgery must have an appropriately documented history and physical examination as well as other indicated consultations and studies, all occurring not more than thirty (30) days prior to the surgical procedure.
3. (3)       In addition to the patient selection criteria required by the registered physician’s credentialing entity, the Board requires adherence to the following safety parameters                     :
4. (a)       Intra-peritoneal and intra-pleural procedures are not permitted to be performed in a physician’s office without prior, written approval from the Board. Intravascular and intraluminal procedures, clinically necessary peritoneal access occurring incidentally to the primary procedure, ventral hernia repair that does not open the peritoneal cavity, and rib harvest that does not enter the pleural space do not require Board approval.
5. (b)       The registered physician must utilize written criteria for the inclusion and exclusion of pediatric patients.
6. (c)        Patients with a history of solid organ transplant, excepting kidney transplant, are not appropriate candidates for an office-based surgical procedure.
7. (d)       A physician shall not perform a Level III office-based surgical procedure on any patient with an American Society of Anesthesiologists (“ASA”) Physical Status Classification greater than or equal to four (4).
8. (e)       For Level III surgery, the registered physician must utilize written evidence-based frailty scoring tools and accompanying procedure-specific exclusion criteria for patients age 75 or older. Patients age 85 or older are not appropriate candidates for a Level III office-based surgical procedure except in emergency or urgent circumstances or without prior, written Board approval.

Author: Alabama Board of Medical Examiners

Statutory Authority: Code of Ala. 1975, §34-24-53.

History: New Rule: Filed October 17, 2003; effective November 21, 2003. Repealed and New Rule: Published January 30, 2026; effective March 16, 2026.