Frequently Asked Questions

Level I office surgeries (Rule 64B8-9.009(3), F.A.C.) include, but are not limited to, the following:

1. Minor procedures such as excision of skin lesions, moles, warts, cysts, lipomas, and repair of lacerations or surgery limited to the skin and subcutaneous tissue performed under topical or local anesthesia not involving drug-induced alteration of consciousness other than minimal preoperative tranquilization of the patient.
2. Liposuction involving the removal of less than 1000cc supernatant fat.
3. Incision and drainage of superficial abscesses, limited endoscopies such as proctoscopies, skin biopsies, arthrocentesis, thoracentesis, paracentesis, dilation of urethra, cystoscopic procedures, and closed reduction of simple fractures or small joint dislocations (i.e., finger and toe joints).
4. Anesthesia is local, topical, or none. There is no drug-induced alteration of consciousness other than minimal preoperative tranquilization of the patient.
5. Chances of complications requiring hospitalization are remote.

Level II office surgeries (Rules 64B8-9.009(4) and (5), F.A.C.) include, but are not limited to, the following:

1. Procedures during which perioperative medication and sedation are administered intravenously, intramuscularly, or rectally, thus making intra- and postoperative monitoring necessary.
2. Hemorrhoidectomies, hernia repairs, reduction of simple fractures, large joint dislocations, breast biopsies, colonoscopies, and liposuction involving the removal of up to 4000cc supernatant fat.
3. Surgeries in which the patient is placed in a state which allows the patient to tolerate unpleasant procedures while maintaining adequate cardiorespiratory function and the ability to respond purposefully to verbal command and/or tactile stimulation. Patients whose only response is reflex withdrawal from a painful stimulus are sedated to a greater degree than encompassed by this definition.

Level III office surgery (Rule 64B8-9.009(6), F.A.C.) is that surgery which involves, or reasonably should require, the use of general anesthesia or major conduction anesthesia and preoperative sedation. This includes, but is not limited to, the use of:

1. Intravenous sedation beyond that defined for Level II office surgery. General anesthesia refers to a loss of consciousness and loss of vital reflexes with probable requirement of external support of pulmonary or cardiac functions or major conduction anesthesia.
2. Only patients classified under the American Society of Anesthesiologist’s risk classification criteria as Class I or II are appropriate candidates to undergo Level III office surgery procedures.

Please print and fill out the Office Surgery Registration Application. Mail the completed application along with the required registration fee and all staff credentials to Department of Health, Post Office Box 6330, Tallahassee, FL 32314-6330.

The fee is $150. See Rule 64B-4.003(2), F.A.C., for more information.

Most registration applications can be processed and approved within 30 days of receiving a complete application. Incomplete applications will take longer to process.

To serve as a Designated Physician, a physician must have a current, active, and unencumbered license and practice medicine at the physician office where office surgeries are to be performed.

No. However, before a Designated Physician can perform office surgeries, he or she must provide all necessary credentials to the Department of Health to demonstrated that he or she is qualified to be added to an office surgery registration. If a Designated Physician does not intend to perform office surgeries, he or she must provide a letter to the Department stating that he or she will practice medicine at the office surgery facility but will not perform office surgeries.

Every Florida licensed physician who holds an active Florida license and performs certain Level I or any Level II or Level III office surgeries in an office surgery facility registered in Florida must register with the Department of Health. It is the physician’s responsibility to ensure that every office in which he or she performs a regulated procedure is registered regardless of whether other physicians are practicing in the same office or whether the office is non-physician owned.

Physicians/surgeons are expected to perform only those surgeries they are competent to perform. Specific education requirements are listed in Rules 64B8-9.009(4)(b)2.a.b. and 64B8-9.009(6)(b)1.a.b., F.A.C.

Unless they are board certified or board eligible and are under a qualifying transfer agreement, physicians who perform Level II or Level III office-based surgeries must have staff privileges to perform the same procedures at a hospital licensed under section 395, F.S. See Rule 64B8-9.009(6)(b)1.a., F.A.C., for more information.

Among other requirements, a physician/surgeon performing Level II or Level III office surgeries needs either staff privileges to perform the same procedures at a licensed hospital or a qualifying transfer agreement with a licensed hospital within 30 minutes travel time. See Rule 64B8-9.009(4)(b)1., F.A.C., for more information.

No, so long as the staff privileges are at a hospital within reasonable proximity (within 30 minutes), and you are able to perform the same procedures with your staff privileges as those performed in the office surgery facility.

All physicians who perform certain Level I or any Level II or Level III surgical procedures in a physician office setting must register the office with the Department of Health unless that office is licensed pursuant to Chapter 390 or 395, Florida Statutes. Office surgery is defined as surgery that is performed outside a hospital, an ambulatory surgical center, abortion clinic, or other medical facility licensed by the Department of Health, the Agency for Health Care Administration, or a successor agency.