Each physician who provides anesthesia services or performs a procedure for which anesthesia services are provided in an outpatient setting, including the use of analgesics and anxiolytics, must register and pay a fee to the Texas Medical Board. The current fee for office-based anesthesia is a total of $210, per physician.
In addition, each physician who registers with the TMB for office-based anesthesia, or OBA, must identify what level of anesthesia services are provided at each practice site, with some exception for anesthesiologists.
Registration for OBA will be combined with the physician biennial registration. If you need to register to provide OBA services between registrations, please contact the Registration Department at Registrations@tmb.state.tx.us , for the proper forms.
Please visit Chapter 173 in the Board Rules for the complete regulations.
Inspections of registered OBA locations in Texas.
In order that we may ensure compliance with Board Rule 173 regarding the provision of anesthesia services in outpatient settings, the Board implemented, starting January 2014, a program to inspect registered OBA locations in Texas.
The Board will provide at least 5 days’ notice prior to inspection. At, or prior to, the time of inspection each physician who has registered an OBA location will be required to provide to the information requested by the Board. Click here for a general OBA Inspection Checklist. Please do not submit any documentation at this time.
Who has to register for office-based anesthesia?
- A physician who provides level II-IV anesthesia services in an outpatient setting (including analgesics and anxiolytics).
- A physician who performs a procedure for which level II-IV anesthesia services are provided in an outpatient setting (including analgesics and anxiolytics).
What is the TMB definition of an analgesic and anxiolytics?
Board rule 192 defines analgesic and anxiolytics as shown below:
Analgesics--Dangerous or scheduled drugs that alleviate pain, but not including non-opioid based drugs such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs).
Anxiolytics--Dangerous or scheduled drugs used to provide sedation and/or to treat episodes of anxiety.
Who does not need to register for office-based anesthesia?
OBA registration does not apply to physicians who practice in the following settings:
- An outpatient setting in which only local anesthesia, peripheral nerve blocks, or both are used.
- Any setting physically located outside the State of Texas.
- A licensed hospital, including an outpatient facility of the hospital that is located apart from the hospital.
- A licensed ambulatory surgical center.
- A clinic located on land recognized as tribal land by the federal government and maintained or operated by a federally recognized Indian tribe or tribal organization as listed by the United States secretary of the interior under 25 U.S.C. (479-1) or as listed under a successor federal statute or regulation.
- A facility maintained or operated by a state or governmental entity.
- A clinic directly maintained or operated by the United States or by any of its departments, officers, or agencies.
- An outpatient setting accredited by:
- the Joint Commission on Accreditation of Healthcare Organizations relating to ambulatory surgical centers;
- the American Association for the Accreditation of Ambulatory Surgery Facilities; or
- the Accreditation Association for Ambulatory Health Care.
- The performance of Mohs micrographic surgery.
- Provide only level I services.
Note: physicians that provide only level I services, must still meet all other requirements under Chapter 173.
What are the standards for anesthesia services relating to OBA?
Physicians and anesthesiologists shall maintain current competency in ACLS, PALS, or a course approved by the board. In all settings under Chapter 192, at a minimum, at least two persons, including the surgeon or anesthesiologist, shall maintain current competency in basic life support.
Verifications of OBA registration are available on request. Please submit a written request by mail, fax or email to:
Texas Medical Board
Attn: Registration Department
P.O. Box 2029 MC 240
Austin, TX 78768
fax - (888) 512-2581
In addition to the general standards that apply to all outpatient settings, the following standards are required for outpatient settings, based upon the level of anesthesia being administered. If personnel and equipment meet the requirements of a higher-level, lower-level anesthesia services may also be provided. See Board rule 173.2 for minimum equipment requirements and standards.
Level I services - Delivery of narcotic analgesics or anxiolytics by mouth, as prescribed for the patient on order of a physician, at a dose levenot to exceed minimal sedation, as defined under Bd rule, or delivery of nitrous oxide/oxygen inhalation sedation.
- A physician and at least two personnel must be present, including the physician who must be currently certified by AHA or ASHI, at a minimum, in BLS; and
- the following age-appropriate equipment must be present:
- bag mask valve; and
- oxygen.
Level II services - The administration of tumescent anesthesia; the delivery of tumescent anesthesia in conjunction with the delivery of narcotic analgesics or anxiolytics by mouth in dosages as defined under Level I, as prescribed for the patient on order of a physician; or except for the performance of Mohs micrographic surgery, the administration of local anesthesia, peripheral nerve blocks, or both in a total dosage amount that exceeds 50 percent of the recommended maximum safe dosage per outpatient visit.
- A physician and at least one other personnel must be present during the procedure and recovery until ready for discharge. The physician must be currently certified by AHA, ASHI, or ASA in ACLS, PALS, or PeRLS as appropriate. The additional personnel member(s) must be currently certified by AHA or ASHI, at a minimum in BLS.
- A crash cart must be present containing drugs and equipment necessary to carry out ACLS protocols, including, but not limited to:
- the age-appropriate monitoring and emergency equipment required under in Board rule 173.2;
- first line cardiac medications, including epinephrine, atropine, adreno-corticoids, and antihistamines;
- benzodiazepines for intravenous or intramuscular administration;
- lipid emulsion to treat local anesthetic systemic toxicity, if administering local anesthesia, peripheral nerve blocks, or both in a total dosage amount that exceeds 50 percent of the recommended maximum safe dosage per outpatient visit (except for Mohs micrographic surgery), or if administering tumescent anesthesia; and
- specific reversal agents, Flumazenil and Naloxone, if benzodiazepines or narcotics are used for sedation.
Level III services - Intravenous, intramuscular, mucosal, rectal or inhalational delivery of narcotic analgesics, anxiolytics, or hypnotics to achieve moderate sedation, as defined in Board rule. Level III services do not include deep sedation or general anesthesia.
- A physician and at least one other personnel must be present during the procedure and recovery until ready for discharge. The physician must be currently certified by AHA, ASHI, or ASA in ACLS or PALS, or PeRLs as appropriate. The additional personnel member(s) must be currently certified by AHA, ASHI, or ASA in ACLS, PALS, or PeRLS, as appropriate.
- A crash cart must be present containing the same drugs and equipment required for Level II, and a backup cylinder of oxygen, except for lipid emulsion.
- Intravenous access must be established.
- Providers must adhere to ASA Standards for Post Anesthesia Care.
Level IV services - The use of regional or neuraxial anesthesia and/or the use of anxiolytics, narcotic analgesics, and/or hypnotics to establish deep sedation or general anesthesia, as defined under this Chapter.
Level IV services do not require physicians to maintain a stock of lipid emulsion. Physicians who practice medicine in Texas and who administer anesthesia or perform a procedure for which anesthesia services are provided in outpatient settings at Level IV shall follow current, applicable standards and guidelines as put forth by the American Society of Anesthesiologists (ASA) including, but not limited to, the following:
- Basic Standards for Pre-anesthesia Care;
- Standards for Basic Anesthetic Monitoring;
- Standards for Post-anesthesia Care;
- Position on Monitored Anesthesia Care;
- The ASA Physical Status Classification System;
- Guidelines for Non-operating Room Anesthetizing Locations;
- Guidelines for Ambulatory Anesthesia and Surgery; and
- Guidelines for Office-Based Anesthesia; and
- Practice sites shall maintain a separate oxygen cylinder as a secondary supply.
Physicians or surgeons must notify the board in writing within 15 days if a procedure performed in any of the settings under these rules resulted in an unanticipated and unplanned transport of the patient to a hospital for observation or treatment for a period in excess of 24 hours, or a patient's death intraoperatively or within the immediate postoperative period. Immediate postoperative period is defined as 72 hours. Please use the form below for notification of unanticipated transfer/hospitalization or death.
Unanticipated Transfer/Hospitalization or Death
Please contact the Registration Department at Registrations@tmb.state.tx.us if you have any additional questions.
How much does OBA registration cost?
The biennial registration fee for office-based anesthesia is a total of $210, per physician and should be combined with the biennial registration.
For off cycle OBA registration, please submit a hard copy registration form with the correct pro-rated fee. Please note that payments for the incorrect OBA pro-rated fee will be voided, causing a delay in the registration process. You may email us to request a pro-rated registration form at registrations@tmb.state.tx.us.
I am an anesthesiologist. I contract out my services to other physicians to provide anesthesia for procedures in their offices. Since the anesthesia is not done in my office and I am only a contractor, do I need to register for Office Based Anesthesia (OBA)?
Yes, both the anesthesiologist and the physician performing the procedure should be registered for OBA. Statute states that each physician who administers anesthesia or performs a procedure for which anesthesia services are performed in an outpatient setting shall register for OBA and comply with current OBA regulations. Please note, an anesthesiologist who contracts out their services to multiple physicians is not required to register each location where they perform OBA, but only the highest level of OBA services that they provide.
How do I verify what level of OBA services an individual is registered for?
Verifications of OBA registration are available on request. Please submit a written request by mail, fax or email to:
Texas Medical Board
Attn: Registration Department
P.O. Box 2029 MC 240
Austin, TX 78768
fax - (888) 512-2581