Ambulatory Surgery Center
Frequently Asked Questions
General
1. What is an Ambulatory Surgery Center?
An ASC facility means "any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission", pursuant to Title 42 Code of Federal Regulations (CFR) section416.2.
2. What is the difference between an ASC and Surgical Clinic (SURGC)?
A clinic may be certified as an ASC. An ASC facility means "any distinct entity that operates exclusively for the purpose of providing surgical services to patients not requiring hospitalization and in which the expected duration of services would not exceed 24 hours following an admission", pursuant to Title 42 CFR section 416.2.
A state license is required to operate a SURGC in California. A SURGC means "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, provided, however, that physicians or dentists may, at their option, apply for licensure," pursuant to Health and Safety Code (HSC) section 1204(b)(1).
If a SURGC is owned by a physician or group of physicians in whole or in part, the California Department of Public Health (CDPH) does not have the authority to license the clinic per the Capen Decision. The clinic qualifies for exemption from licensure pursuant to HSC § 1206(a).
3. If my ASC is owned by a physician or group of physicians in whole or in part, can I still apply for a license as a SURGC?
No, any ASC that has any degree of physician ownership is exempt from licensure as a surgical clinic as described in the Capen decision. This decision determined that if a SURGC is owned partly or entirely by a physician then the clinic will be exempt from the licensure requirements.
4. What if my ASC is not owned by a physician or group of physicians in whole or in part? Am I required to have my clinic licensed as a SURGC?
The Centralized Applications Branch (CAB) will request the clinic to provide an explanation of their exemption status, pursuant to HSC § 1206. CAB will confirm demonstration of the requested HSC § 1206 subsection, and may request additional documentation to substantiate the clinic’s exemption status. If CAB confirms the clinic meets HSC 1206 subsection requirements, the clinic will be reviewed and processed as a license exempt ASC.
5. What if my ASC is not owned by a physician or group of physicians in whole or in part and does not meet one of the HSC § 1206 subsections?
CAB will require the clinic to be licensed as a SURGC pursuant to HSC § 1204(b)(1).
6. Which medical license is required as a physician for purposes of qualifying as a license-exempt ASC?
To qualify as a license-exempt ASC under HSC § 1206(a), the health care practitioner must be licensed by the Medical Board of California (MBC) as a “physician and surgeon,” pursuant to the California Code of Regulations (CCR) Title 22, § 73085. This licensure is granted to individuals who meet the required criteria, one of which is holding a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
Application Processing
7. What is the application review process for an Initial ASC certification?
All Facilities Letter (AFL) 25-19 notifies facilities of a change to the application review process for all application submitted to CAB. Effective July 1, 2025, incomplete applications will be denied. Below is an overview of the application process for an Initial ASC certification application:
When an ASC seeks to participate in the federal Medicare program, it must first complete and submit an enrollment application to the Center for Medicare and Medicaid Services (CMS). Information on enrollment, as well as applicable forms and instructions ca be found on the
CMS website (https://www.cms.gov/medicare/enrollment-renewal/providers-suppliers). CMS delegates Medicare enrollment application review to the Medicare Administrative Contractor (MAC). The MAC for California is Noridian. Once the ASC submits their initial enrollment application, Noridian will review for enrollment and either:
- Sends the ASC a recommendation for approval letter, or
- Denies the application based on enrollment criteria.
If the ASC receives a recommendation for approval letter, the clinic must then submit an Initial certification application to CAB. When CAB receives an application and it is assigned to an analyst, the analyst will conduct a prescreen review. CAB will identify if all required forms/documents are submitted:
- CAB will issue a one-time prescreen letter requesting any missing forms or documents, with a deadline of 21-calendar days.
- If CAB does not receive the requested forms or documents within 21-calendar days of the date of the letter, the application will be denied, and you will be required to resubmit your application.
If all required forms and documents are received, the analyst will conduct a full review of the application:
- Each form/document is reviewed for completion and accuracy, ensuring all information has been captured and to determine whether the facility meets applicable federal requirements.
- Database checks and compliance histories are conducted to ensure the applicant is of reputable and responsible character.
- If any deficiencies have been identified, a correction letter is issued to the Application Contact, with a deadline of 60-calendar days.
- CAB will continue to process the application if additional information and/or corrections are received timely.
- If CAB does not receive the requested information and/or corrections within 60-calendar days of the date of the letter, the application will be denied.
Once CAB receives the corrections and completes the review, the application will be sent to the district office (DO), who will schedule a certification survey. The ASC must notify the DO if the clinic selects an Accrediting Organization (AO) to conduct the certification survey. The certification survey will be unannounced to ensure the ASC is compliant with applicable conditions of participation. Based on survey results, the DO and AO will either:
- Recommend Medicare approval and notify CMS of the recommendation for approval in the Medicare program or,
- Recommend denial from participation in the Medicare program
If the DO or AO recommends approval, CMS will issue the CMS Certification Number (CCN) for the ASC to bill and participate in the Medicare program.
8. Is there an application fee required for an ASC Initial certification, change of ownership (CHOW), or report of change (ROC) application?
No fee is required for ASC Initial certification, CHOW, or ROC applications.
9. I am a physician owned ASC exempt from licensure. However, I am applying for Medicare/Medi-Cal certification. Am I required to submit any application documents to CAB?
Yes, an application must be submitted to CAB. CAB collects and reviews all required certification documents and forwards the information to the DO, who handles the certification survey.
10. I submitted an initial Medicare enrollment application to CMS. I followed up with the DO, but they do not have a copy of this application. What should I do?
If the ASC receives a recommendation for approval letter from Noridian, the clinic must then submit an Initial certification application to CAB. Noridian does not forward a copy of your initial Medicare enrollment application to CAB. For further information please visit the
Licensing and Certification Division website (https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/ApplyForLicensure-Paper.aspx), select Ambulatory Surgical Clinic and select the appropriate application type drop down for further instructions.
11. Why do I need to submit a separate application to CAB for initial certification and/or report of change for an ASC if I have already updated my information through the CMS system (PECOS) and completed a CMS 855B?
CAB is the intermediary between CMS and the Department of Health Care Services (DHCS) to collect the Medicare/Medi-Cal certification forms on their behalf. For any ASC provider intending to update the facility's Medicare/ Medi-Cal certification information, an application must be submitted to CAB. For further information please visit the
Licensing and Certification Division website (https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/ApplyForLicensure-Paper.aspx), select Ambulatory Surgical Clinic and select the appropriate application type drop down for further instructions.
12. We maintain an accredited and Medicare-certified ASC and would like to open a satellite facility under the same ownership and management. What state application is required for this second location?
An Initial ASC certification application is required. For further information please visit the
Licensing and Certification Division website (https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/ApplyForLicensure-Paper.aspx), select Ambulatory Surgical Clinic and select the appropriate application type dropdown for further instructions.
13. Is an STD 850 – Fire Safety Inspection Request form required for an Initial ASC application?
Yes, the STD 850 is required for an Initial ASC application.
14. How can I ensure that my Initial application is processed timely?
Applications that are missing forms/documents will be denied. CAB will only process completed applications. Please ensure the following are completed:
- All required forms/documents are submitted to avoid processing delays.
- All applicable fields on each form/document are completed.
- If the clinic is physician-owned, ensure physician ownership is captured either in the cover letter or organizational chart.
15. How can I check the status of my application?
When the application is assigned to an analyst, you will be able to contact the analyst directly. If you have not received a response, visit the
Contact Us page (https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/CAB-Contact-Page.aspx) for more information on the appropriate inbox for questions and inquiries regarding Initial, CHOW, and ROC ASC applications.
16. Can I contact our local DO to find out the status of the Initial certification survey?
Yes, providers may contact their local DO to inquire the status of a pending certification survey. Please reference your application ID when contacting your
local DO (https://www.cdph.ca.gov/Programs/CHCQ/LCP/Pages/DistrictOffices.aspx).
17. Do I mail a completed application to CAB, or email an electronic file?
Please submit completed application packets to the CAB address listed below:
California Department of Public Health
Center for Health Care Quality
Centralized Applications Branch
P.O. Box 997377, MS 3207
Sacramento, CA 95899
Electronic application submissions will not be accepted. Do not send any completed application packets, forms, or supporting documents to the local DO
18. Do I need to submit application documents with original signatures?
CAB can accept documents submitted through mail with original signatures, or PDF electronic signatures in lieu of original signatures. If a CAB analyst issues a deficiency letter to the facility contact, the analyst may also accept copies of original signatures that are submitted as PDFs.
19. Does an application to CAB require a copy of the CMS 855B – Medicare General Enrollment Health Care Provider/Supplier Application?
A copy of the CMS 855B is not required to be submitted to CAB.
20. What if CAB denies my application (Initial, CHOW, ROC)?
Local DOs will be notified of application and notification approvals and denials. Applicants may submit an appeal regarding a denied application and complete the appeal process, or applicants may resubmit another application packet.