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Medical Office Building (MOB) CAM Reconciliation Guide for Landlords

Typical CAM pools, billing errors, gross-up mechanics, and BOMA standards for medical office building (mob) properties.

Benchmark CAM per SF

$9.00 – $17.00 / SF

Source: Revista / BOMA Medical Office 2024

Gross-Up Applicability

Relevant — MOBs near hospitals may have uneven occupancy as practices consolidate. Enhanced HVAC and janitorial standards mean variable expenses are higher per SF and should be grossed up at standard occupancy.

Typical CAM Pools

  • Janitorial (medical-grade)
  • HVAC maintenance (enhanced)
  • Elevator maintenance
  • Security
  • Utilities (common area)
  • Medical waste management (shared)
  • Insurance
  • Property taxes
  • Management fees
  • Parking maintenance

Standard Exclusions

  • Tenant-specific medical equipment
  • Individual suite build-out
  • Capital improvements
  • Leasing commissions
  • Tenant medical waste (individual)

Common Lease Structures

Modified grossFull-service gross with base yearNNN (less common)

Common Billing Errors

  • Passing through medical-grade HVAC costs to non-medical tenants in mixed buildings
  • Including after-hours HVAC charges in base CAM rather than billing individually
  • Misallocating parking structure costs between medical and non-medical tenants

Relevant BOMA Standards

  • ANSI/BOMA Z65.1-2024 (Office Buildings)
  • Special provisions for medical suites requiring higher ventilation

Medical Office Building (MOB) CAM Context

Medical office buildings command premium CAM charges due to enhanced HVAC (fresh air requirements, negative pressure rooms), medical-grade janitorial services, and specialized common areas (waiting rooms, imaging suites). After-hours usage is a frequent billing dispute.

Industry Benchmarks

Avg Occupancy (2025)
85.8%
Public REIT average
Median OpEx/SF
$17.68
Annual operating expenses
Typical Recovery Ratio
85-95%
Full-service gross leases recover less; modified gross and N...

Source: Public REIT 10-K filings (FY 2025), BOMA EER (2025 edition). Data compiled March 2026.

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Related Resources

Expenses/Administrative OverheadBoma/Boma 2024 Adoption RoadmapCam Reconciliation ErrorsCam Gross Up CalculatorPro Rata Calculator

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