QUAD A outpatient accreditation is an onsite survey of an office-based surgical, procedural, oral and maxillofacial surgery or pediatric dentistry facility against the QUAD A standards manual for that program, and QUAD A "requires 100% compliance with all standards." It is for surgical and office procedural organizations that have chosen QUAD A, are moving to it, or need it before they can be licensed. Integral Healthcare Solutions (IHS) aligns your operating documents and quality records to QUAD A; your surgeons and anesthesia providers approve the clinical content.

Last reviewed: October 2026.

What is QUAD A outpatient accreditation?

QUAD A lists four outpatient programs (QUAD A, Outpatient Programs):

• Office-Based Procedural (OBP), "intended for ambulatory facilities performing procedures under sedation."
• Office-Based Surgery (OBS), "designed to promote optimal patient safety in the office setting."
• Oral Maxillofacial Surgery (OMS).
• Pediatric Dentistry.

Each program has its own standards manual. QUAD A's prospective facilities page lists these, each effective 04-07-2025: OBS Standards Manual v.16.0, OBP Standards Manual v.6.0, OMS Standards Manual v.4.0, Pediatric Dentistry Standards Manual v.3.0, and, for the Medicare ASC program, the ASC Program Standards Manual v.9.0 (QUAD A, Prospective Facilities). Confirm the version on the manual you hold before you start, since QUAD A may revise it.

The bar is high. "QUAD A requires 100% compliance with all standards" (QUAD A, Fee Schedule). The OBS and OBP requirements run from "anesthesia equipment inspections to record-keeping, controlled substances, infection control, and emergency preparedness" (QUAD A, OBP and OBS).

The steps are set out on the prospective facilities page: "Facilities can now apply for QUAD A accreditation online." The facility submits documents through the QUAD A Portal, works with a dedicated accreditation specialist, schedules an onsite survey, receives a formal report, and submits a Plan of Correction for any deficiencies (QUAD A, Prospective Facilities). "QUAD A facility surveyors are board-certified physicians, dentists, licensed nurses, or physical therapists trained to perform a thorough and complete facility survey" (same page).

Who needs it and what triggers it

The buyer is a surgical or office procedural organization that has picked QUAD A. The work usually starts with one of these events:

• A new facility in a state that requires accreditation for licensure. "New facilities located in states that require accreditation before they can obtain licensure must undergo a Start-Up survey prior to conducting any cases." QUAD A adds: "Currently, facilities located in California, New York, Florida, Indiana, Nevada, Ohio, Texas, and Washington may require a Start-Up survey. This list is not intended to be exhaustive" (QUAD A, Fee Schedule).
• Adding sedation or surgery in the office. A practice that begins procedures under sedation, or office surgery, chooses between the OBP and OBS programs (QUAD A, Outpatient Programs).
• Choosing or switching accreditors. An organization selects QUAD A for the first time, moves from another accreditor, or adds QUAD A as a further accreditation objective.
• Re-survey. "Every third year, when the facility is due for re-survey, the facility's invoice includes the survey fee and the annual fee" (QUAD A, Fee Schedule).

How IHS helps

IHS works from the QUAD A standards manual for the program you select. The process:

1. Gap assessment. Each standard in the manual is read against what your facility does and documents today. With a 100% compliance requirement, every gap is listed, not only the large ones.
2. Questionnaires and evidence mapping. IHS sends questionnaires on procedures performed, anesthesia, staffing and quality records, then builds a crosswalk from each standard to its evidence.
3. Drafting. IHS drafts operating policies, role assignments and quality-record templates. Anesthesia and procedural content goes to your physicians for approval.
4. Mock inspection. Before the onsite survey, IHS reviews your records against the manual as a surveyor would and lists what is missing.
5. Readiness support. If the survey report lists deficiencies, IHS drafts Plan of Correction responses for your facility to submit.

What you supply: the manual, current policies, credentialing files, procedure logs, and physicians and anesthesia providers who review and approve clinical content.

The limit: surgical, anesthesia and physical-plant safety judgments belong to your clinicians and facility staff. IHS describes its process here and does not claim prior QUAD A engagements. Your facility applies to and corresponds with QUAD A; IHS drafts, and you submit.

What to have ready

Each item below ties to the QUAD A standards manual for your program (for example, OBS v.16.0 or OBP v.6.0, effective 04-07-2025) or to the QUAD A pages and fee schedule, read October 2026.

• The standards manual and version for your program, as listed on the QUAD A prospective facilities page.
• A program choice. OBP is "intended for ambulatory facilities performing procedures under sedation"; OBS is "designed to promote optimal patient safety in the office setting" (QUAD A, Outpatient Programs).
• The Portal application set for OBS or OBP: the Application, Facility Identification and Staff Identification forms (QUAD A, OBP and OBS).
• Uploads for the same application: licenses, privileges, floor plans and the Anesthesia Validation Form (same page).
• Records covering "anesthesia equipment inspections to record-keeping, controlled substances, infection control, and emergency preparedness" (same page).
• Evidence for every applicable standard, because "QUAD A requires 100% compliance with all standards" (QUAD A, Fee Schedule).
• A calendar that allows for scheduling: "QUAD A requires a minimum of 30 days from receipt of a completed packet of application or reaccreditation materials to schedule a survey" (same document).
• For a new facility in a state that requires accreditation for licensure, a Start-Up survey date before your first case (same document).
• A budget line for QUAD A's annual and survey fees, from the published fee schedule (see the cost section below).
• A named owner for the Plan of Correction, which the facility submits for any deficiency the survey report lists (QUAD A, Prospective Facilities).

If you want to go through this list with IHS, start with the introductory call.

How it compares

The table describes scope only. Which route fits depends on your procedures, your state and your payers.

What it costs

QUAD A publishes a fee schedule. It states: "Fees are effective for all invoices as of April 07, 2025" and "Annual fee and survey fees are subject to change" (QUAD A, Fee Schedule). From that schedule:

• Non-Medicare programs (OBS and OBP). The annual fee depends on physicians on staff, specialties and class, from "$869" (1-2 physicians, up to 2 specialties, Class A) to "$7,755" (10 plus physicians, 3 or more specialties, Classes B & C). Survey: "$2,560 Full Survey fee for any size facility or any class."
• Pediatric dentistry. "$2,560 Survey Fee for any size facility or any class."
• Medicare Surgical (ASC). "$4,130 Full Survey Fee for small size facilities", "$5,480 Full Survey Fee for medium size facilities", "$6,280 Full Survey Fee for large size facilities", plus an "Additional $3,135 Life and Safety Code Survey Fee" that the ASC fee table lists as required for all ASC facilities. The schedule's follow-up survey text separately describes a $3,135 fee when a condition-level Life Safety Code deficiency requires an additional survey, so your facility confirms with QUAD A how the fee applies. ASC annual fees vary by physicians, specialties and class.
• Start-Up survey. "A Start-Up Survey Fee of $1,103 applies per survey (up to two allowed)," plus "A Start-Up Term fee of 50% of the published annual rate for that facility," which reflects the six-month accreditation term granted after a successful Start-Up Survey.
• Expedited survey (non-Medicare). "An administrative fee of $550 applies to all expedited survey requests."

In a re-survey year, "the facility's invoice includes the survey fee and the annual fee." Verify current fees with QUAD A.

IHS scopes each engagement after a free introductory call.

What this is not

• IHS is not QUAD A and does not grant, influence or predict an accreditation decision.
• IHS does not apply to, submit to or correspond with QUAD A or a state agency for your facility. Your facility does.
• IHS does not make surgical, anesthesia or physical-plant safety judgments, and this page is not legal advice on state licensure.

Frequently asked questions

What is QUAD A accreditation and which outpatient settings does it cover?

QUAD A accredits outpatient facilities through four programs: Office-Based Procedural, Office-Based Surgery, Oral Maxillofacial Surgery and Pediatric Dentistry (QUAD A, Outpatient Programs). It also lists a Medicare ASC program with its own standards manual (QUAD A, Prospective Facilities). Each program is surveyed against its own manual.

Office-Based Surgery vs Office-Based Procedural: which QUAD A program fits my practice?

QUAD A describes OBP as "intended for ambulatory facilities performing procedures under sedation" and OBS as "designed to promote optimal patient safety in the office setting" (QUAD A, Outpatient Programs). The choice turns on what you perform and under what anesthesia. Read both manuals, OBS v.16.0 and OBP v.6.0, against your procedure list.

Does my state require office-based surgery accreditation before I can operate?

Some states do. QUAD A states that new facilities "in states that require accreditation before they can obtain licensure must undergo a Start-Up survey prior to conducting any cases," and names California, New York, Florida, Indiana, Nevada, Ohio, Texas and Washington as states that "may require a Start-Up survey," adding that the list "is not intended to be exhaustive" (QUAD A, Fee Schedule). Confirm your own state's rule with your counsel; this page is not legal advice.

How long does QUAD A accreditation take from application to accreditation?

QUAD A states: "Statistically, most facilities fully achieve accreditation 90 to 150 days after submitting an application" (QUAD A, FAQ). It also requires "a minimum of 30 days from receipt of a completed packet" to schedule a survey (QUAD A, Fee Schedule). QUAD A counts the 90 to 150 days from submitting an application, and the 30-day minimum from a completed packet. Preparation time comes before both.

How much does QUAD A accreditation cost for a small office-based surgery practice?

Under the fee schedule effective April 07, 2025, the non-Medicare annual fee starts at "$869" for 1-2 physicians, up to 2 specialties, Class A, and the full survey fee is "$2,560" for any size facility or class (QUAD A, Fee Schedule). QUAD A states that fees are subject to change. Verify current fees with QUAD A.

What documents does the QUAD A Portal application require?

For OBS and OBP, the Portal application includes the Application, Facility Identification and Staff Identification forms, plus uploaded licenses, privileges, floor plans and an Anesthesia Validation Form (QUAD A, OBP and OBS). A dedicated accreditation specialist works with the facility through the process (QUAD A, Prospective Facilities).

What does the QUAD A onsite survey review, and who are the surveyors?

The requirements run from "anesthesia equipment inspections to record-keeping, controlled substances, infection control, and emergency preparedness" (QUAD A, OBP and OBS). "QUAD A facility surveyors are board-certified physicians, dentists, licensed nurses, or physical therapists trained to perform a thorough and complete facility survey" (QUAD A, Prospective Facilities).

What happens if the survey finds deficiencies, and how does the Plan of Correction work?

After the onsite survey the facility receives a formal report and submits a Plan of Correction for any deficiencies (QUAD A, Prospective Facilities). Because "QUAD A requires 100% compliance with all standards" (QUAD A, Fee Schedule), each deficiency needs a response. IHS can draft those responses; your facility submits them.

How often is a QUAD A facility re-surveyed?

Every third year for the routine onsite survey. QUAD A's FAQ states: "An accredited facility must undergo re-evaluation through an annual self-survey, an onsite survey every three years, and comply with all QUAD A accreditation standards" (QUAD A, FAQ). The fee schedule adds that facilities "may require additional surveys during the interim period between routine surveys" after events such as major renovations or changes in ownership (QUAD A, Fee Schedule). Medicare-participating ASCs also have a Life Safety survey in the re-survey year.