Level I services - Delivery of analgesics or anxiolytics by mouth, as prescribed for the patient on order of a physician, at a dose level low enough to allow the patient to remain ambulatory. 

1. 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
2. the following age-appropriate equipment must be present:
1. bag mask valve; and
2. oxygen.

Level II services -  The administration of tumescent anesthesia; the delivery of analgesics or anxiolytics by mouth in dosages greater than allowed at Level I, as prescribed for the patient on order of a physician; or (except as provided by Board rule §192.2(b)(9) relating to Provision of Anesthesia Services in Outpatient Settings), 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. 

1. at least two personnel must be present, including the physician who must be currently certified by AHA or ASHI, at a minimum, in ACLS or PALS, as appropriate;
1. another person must be currently certified by AHA or ASHI, at a minimum, in BLS; and
2. a licensed health care provider, who may be one of the two required personnel, must attend the patient, until the patient is ready for discharge; and
2. a crash cart must be present containing drugs and equipment necessary to carry out ACLS protocols, including, but not limited to, the following age-appropriate equipment:
1. bag mask valve and appropriate airway maintenance devices;
2. oxygen;
3. AED or other defibrillator;
4. pre-measured doses of first line cardiac medications, including epinephrine, atropine, adreno-corticoids, and antihistamines;
5. IV equipment;
6. pulse oximeter;
7. EKG Monitor;
8. benzodiazepines for intravenous or intramuscular administration; and lipid emulsion if, (except in the performance of Mohs micrographic surgery, as provided by rule) 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, or if administering tumescent anesthesia, for treating local anesthetic systemic toxicity; and
9. specific reversal agents, flumazenil and nalaxone, if benzodiazepines or narcotics are used for sedation.

Level III services - Delivery of analgesics or anxiolytics other than by mouth, including intravenously, intramuscularly, or rectally. 

1. at least two personnel must be present, including the physician who must be currently certified by AHA or ASHI, at a minimum, in ACLS or PALS, as appropriate;
1. another person must be currently certified by AHA or ASHI, at a minimum, in BLS;
2. a licensed health care provider, which may be either of the two required personnel, must attend the patient, until the patient is ready for discharge; and
3. a person, who may be either of the two required personnel, must be responsible for monitoring the patient during the procedure; and
2. the same equipment required for Level II;
3. establishment of a working intravenous feed;
4. the presence of appropriate antagonists (i.e. Naloxone and Flumazenil); and
5. adherence to ASA Standards for Postanesthesia Care.

Level IV services - Delivery of general anesthetics, including regional anesthetics and monitored anesthesia care; spinal, epidural, or caudal blocks for the purposes of providing anesthesia or monitored anesthesia care. 

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:

1. Basic Standards for Pre-anesthesia Care;
2. Standards for Basic Anesthetic Monitoring;
3. Standards for Post-anesthesia Care;
4. Position on Monitored Anesthesia Care;
5. The ASA Physical Status Classification System;
6. Guidelines for Non-operating Room Anesthetizing Locations;
7. Guidelines for Ambulatory Anesthesia and Surgery; and
8. Guidelines for Office-Based Anesthesia.