Medical Spa Laws and Requirements in Texas

By Khadija Sukhera, Barrister, Lincoln's Inn · Medically reviewed by Patrick Blake, MD, FAAD · Last updated 2026-10-22

This guide provides general information, not legal advice. Laws change, so confirm requirements with your state's medical board and an attorney licensed in your state. Last reviewed 2026-10-22.

According to TDLR, Medical Spas page, regulation of Texas med spas depends on the services offered: TDLR regulates cosmetology, massage therapy, and laser hair removal, while the Texas Medical Board regulates medical acts. Confirm the licenses and permits for your planned services with those agencies and the Texas Department of State Health Services. Because the regulatory environment is complex and varies by state, this guide clarifies Texas's rules on ownership, licensing, and supervision to help you operate your clinic with confidence and full compliance.

How Medical Spa Laws Work in Texas

In Texas, a medical spa is a hybrid clinic offering non-invasive cosmetic medical procedures, while a traditional day spa provides non-medical services like facials and massages. This distinction is crucial because any service considered the practice of medicine subjects the facility to specific medical spa laws in Texas. Consequently, your med spa is legally viewed as a medical practice, which dictates who can own a med spa and requires strict med spa compliance.

The primary reason for these med spa regulations is patient safety, as treatments like injectables and laser therapies are medical procedures that carry inherent risks. To ensure high standards of care, several state agencies oversee spas in Texas and define the medical spa requirements Texas. These include the Texas Medical Board, the Texas Department of License and Regulation, and the Texas Department of State Health Services.

Medical Spa Requirements in Texas

To achieve full med spa compliance, you must meet several key medical spa requirements Texas has established. Under Texas law, Tex. Bus. Orgs. Code 301.012 allows physicians and physician assistants to co-own a professional association or professional limited liability company for services within their scopes of practice, with PAs collectively limited to a minority interest and each PA's share smaller than every individual physician owner's share. Confirm your proposed ownership structure with the Texas Medical Board or a health care attorney. These med spa regulations also mandate physician supervision over all medical procedures, proper staff credentialing, and securing all necessary business and medical licenses to operate legally.

Medical Spa Ownership & Business Structure Requirements in Texas

The medical spa ownership laws Texas enforces are guided by the state's Corporate Practice of Medicine (CPOM) doctrine. As noted above, Texas law includes a physician-assistant ownership option under Tex. Bus. Orgs. Code 301.012, subject to its collective and individual ownership limits. This rule is a key part of the state's med spa regulations, designed to protect the integrity of medical decision-making.

For non-physicians wondering who can open a med spa, the answer involves a Management Services Organization (MSO) structure. Through an MSO, a non-physician can manage the business operations while the physician-owned medical practice handles all clinical services. The medical practice is often a professional limited liability company (PLLC), while the MSO operates as a separate business entity.

For delegated nonsurgical medical cosmetic procedures, 22 TAC 169.26 (Texas Medical Board, eff. 1/9/2025) requires the delegating physician to ensure appropriate training and a signed, dated protocol. 22 TAC 169.27 (Texas Medical Board, eff. 1/9/2025) also requires that physician to approve existing written orders in writing or develop written orders for the delegated acts. Fulfilling these duties is fundamental to meeting the medical spa requirements Texas has established and maintaining full med spa compliance.

Facility, Licensing, and Compliance Requirements in Texas

TDLR's Medical Spas page says a medical office offering esthetic services through an esthetician should have a TDLR establishment license, and 25 TAC 289.301 requires DSHS registration authorizing Class 3B or Class 4 laser use. Confirm with TDLR, DSHS, or Texas health care counsel how these requirements and the separate license for each laser hair removal facility under Tex. Health & Safety Code 401.510 apply, including that statute's exemptions for facilities owned or operated by physicians for medical practice, licensed hospitals, and clinics owned or operated by licensed hospitals. Your facility will also need to pass inspections to receive fire and health department permits. These steps are a core part of the medical spa requirements Texas has in place for all new clinics.

HHS, HIPAA FAQ on certification states that covered entities do not need to certify HIPAA compliance and that HHS does not endorse private Security Rule certifications. Separately, Tex. Health & Safety Code 181.001(b)(2) and 181.101 requires entities covered by Texas health privacy law to provide employee training appropriate to their duties concerning protected health information. Your clinic must also follow state health department rules for sanitation and infection control. The supervising physician is responsible for staff training in procedure techniques, complication management, and infectious disease control.

Texas Medical Board, Patient Information and Medical Records states that Texas physicians are not legally required to carry malpractice insurance. Confirm insurance obligations for your business and providers with the Texas Medical Board or a health care attorney. Under 22 TAC 164.3(b)(8) (Texas Medical Board), failing to disclose medical directorship, supervision of, or delegation to non-physicians is misleading advertising when care is delivered under standing orders and protocols at a location other than the physician's primary practice location. Finally, proper recordkeeping is essential, requiring you to maintain adequate medical records for every patient.

Who Can Perform Medical Spa Procedures in Texas?

In Texas, procedures like injectables, laser treatments, IV therapy, and microneedling are classified as nonsurgical medical cosmetic procedures, which are legally considered the practice of medicine. This distinction is a core part of the medical spa laws in Texas, separating these treatments from non-medical services like facials that a licensed esthetician can perform. Adhering to these med spa regulations is essential for med spa compliance and patient safety.

The medical spa requirements Texas enforces strictly define who can perform these medical services. Here are the allowed providers and their roles:

• Physicians (MD/DO): May delegate medical acts to qualified, properly trained people under physician supervision subject to the conditions in Tex. Occ. Code 157.001, while remaining responsible for those acts. For delegated nonsurgical medical cosmetic procedures, 22 TAC 169.26 (Texas Medical Board, eff. 1/9/2025) also permits a PA or APRN acting under physician delegation to establish the practitioner-patient relationship and allows a physician, PA, or APRN to provide onsite presence or immediate availability for emergency consultation. The physician must also be able to conduct an emergency appointment if necessary.
• Physician Assistants (PAs) and Advanced Practice Registered Nurses (APRNs): Can perform medical procedures under the supervision of a licensed physician after the physician issues an order.
• Registered Nurses (RNs): Can perform certain delegated medical procedures, such as administering Botox or performing microneedling, but must be supervised by a physician.
• Estheticians and Medical Assistants: May receive physician-delegated medical acts if qualified and properly trained, subject to the physician supervision, sound medical judgment, safe and proper performance, customary practice, statutory compliance, and public representation conditions in Tex. Occ. Code 157.001. For elective intravenous therapy as defined in Tex. Occ. Code 172.051(b) and 172.001(2) (HB 3749, eff. September 1, 2025), whose definition excludes therapy administered in a physician's office, physician delegation is limited to PAs, APRNs, and RNs acting under adequate physician supervision.

A physician may delegate medical acts but is ultimately responsible for the quality of care and must ensure the provider has received appropriate training. According to Texas Medical Board rules, this training must cover procedure techniques, contraindications, and managing complications. For full compliance, a physician, PA, or APRN must be on-site or immediately available for emergencies during any delegated procedure.

Laser & Energy Device Regulations in Texas

Texas law defines a prescription medical device by FDA designation and sale restricted to people with prescriptive authority in their state under 22 TAC 169.1(10) (Texas Medical Board), and 22 TAC 169.25(a)(1) (Texas Medical Board, eff. 1/9/2025) treats cosmetic use of a prescription medical device as the practice of medicine. Confirm the classification and applicable rules for each device with the Texas Medical Board or a health care attorney. This classification is a key part of the medical spa laws in Texas, subjecting these treatments to oversight from both the Texas Medical Board and, for certain services like laser hair removal, the Texas Department of License and Regulation. Understanding this framework is fundamental to your med spa compliance.

Alongside the written orders discussed above, 22 TAC 169.26 requires a physician, or a PA or APRN acting under physician delegation, to establish a practitioner-patient relationship and complete and maintain adequate medical records before a delegated nonsurgical cosmetic medical act. While a physician, PA, or APRN can operate these devices, a physician may delegate the task to other qualified and trained individuals. However, one of the core medical spa requirements Texas enforces is that a physician, PA, or APRN must be on-site or immediately available for emergencies during the treatment.

The supervising physician is responsible for ensuring any delegated staff receives appropriate training in procedure techniques, contraindications, complication management, and infection control. While Texas does not have a single registration for all laser technicians, agencies like the TDLR set specific certification requirements for procedures under their purview. The delegating physician remains fully responsible for patient safety and all aspects of the procedure, including the management of any complications.

Medical Spa Enforcement, Penalties & Risk Management in Texas

Failing to adhere to the medical spa laws in Texas can expose your practice to significant legal and financial risks. State agencies, particularly the Texas Medical Board, actively enforce these med spa regulations to protect public safety. Violations can result in severe penalties, including cease-and-desist orders, substantial fines, and disciplinary action against a physician’s license. Understanding these risks is the first step toward building a resilient and compliant practice.

Many enforcement actions arise from common, often unintentional, mistakes. Here are some of the most frequent compliance issues for spas in Texas:

• Improper Delegation: Assigning a medical procedure to an individual who is not qualified or properly supervised under Texas law, such as having an esthetician perform laser treatments.
• Unlicensed Practice of Medicine: This can occur through incorrect business structures that violate the Corporate Practice of Medicine doctrine, which dictates who can own a med spa.
• Inadequate Supervision: Failing to have a physician, PA, or APRN on-site or immediately available during a delegated medical procedure.
• False or Misleading Advertising: Promoting services without clearly disclosing physician oversight or making claims that cannot be substantiated.

Proactive risk management is essential for maintaining med spa compliance and protecting your business. To help you stay ahead of the complex medical spa requirements Texas mandates, we recommend implementing these best practices:

• Conduct Regular Compliance Audits: Periodically review your clinic’s protocols, patient records, and operational procedures to ensure they align with current med spa regulations. This is a critical step, as med spa laws by state can change.
• Prioritize Staff Training and Credentialing: Maintain a detailed log of all staff training, certifications, and licenses. Ensure every team member understands their specific scope of practice.
• Maintain Thorough Documentation: Keep organized records of everything, including physician orders, patient consent forms, delegation protocols, and equipment maintenance logs. Proper documentation is your best defense in an audit.

Stay Compliant with Portrait Care in Texas

Operating a compliant medical spa in Texas requires careful attention to ownership structures, physician supervision, and staff credentialing. By following the state's med spa regulations—from adhering to the Corporate Practice of Medicine doctrine to maintaining thorough documentation—you build a foundation of safety and trust that protects both your patients and your practice. You can learn more about opening a compliant med spa with our comprehensive guide.

This content is for informational purposes only and is not a substitute for professional legal advice. We encourage you to consult with a qualified healthcare attorney to ensure your practice meets all of Texas's legal requirements.

Portrait Care is built to help you manage compliance and grow your practice with confidence. Schedule a demo today to see how our all-in-one platform can support your clinic.

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• Medical Spa Laws and Requirements in El Paso
• Medical Spa Laws and Requirements in Fort Worth

Official sources for Texas med spa rules

Med spa rules vary and can change. This guide summarizes requirements but does not replace current rules from the relevant regulators.

Before acting, confirm requirements for your license type and services with the Texas Medical Board and the Texas Board of Nursing.

Frequently Asked Questions

Can a non-physician own a med spa in Texas?

Tex. Bus. Orgs. Code 301.012 permits physicians and physician assistants to co-own professional associations or professional limited liability companies for services within their scopes of practice, with PAs collectively limited to a minority interest and each PA's share smaller than every individual physician owner's share. Confirm your proposed ownership and management structure with the Texas Medical Board or a health care attorney.

Can an esthetician perform medical treatments at a Texas med spa?

An esthetician license supports non-medical services such as facials, rather than authority to perform medical treatments in Texas. Injectables, laser treatments, IV therapy, and microneedling are classified as medical procedures requiring physician supervision and proper staff credentials. Your state board is the authority on treatment-specific scope and delegation requirements.

Does a med spa in Texas need a medical director?

For delegated nonsurgical medical cosmetic procedures, 22 TAC 169.26 requires the delegating physician to ensure appropriate training and a signed, dated protocol, while 22 TAC 169.27 requires physician-approved or physician-developed written orders. TDLR's Laser Hair Removal FAQ says a laser hair removal facility needs a written contract with a consulting physician, rather than a medical director. Confirm the arrangement for your services with the Texas Medical Board, TDLR, or a health care attorney.

What licenses and permits do I need for a med spa in Texas?

TDLR's Medical Spas page says a medical office where an esthetician provides esthetic services should have an establishment license from TDLR, while 25 TAC 289.301 requires a DSHS registration certificate authorizing Class 3B or Class 4 laser use. Tex. Health & Safety Code 401.510 requires a license for each laser hair removal facility, exempting a facility owned or operated by a physician for the practice of medicine, a licensed hospital, or a clinic owned or operated by a licensed hospital. Confirm applicable licenses and registrations with TDLR, the Texas Department of State Health Services, or Texas health care counsel.

Does a Texas med spa have to disclose physician supervision in ads?

22 TAC 164.3(b)(8) treats failure to disclose medical directorship, supervision of, or delegation to non-physicians as misleading advertising when care is delivered under standing orders and protocols at a location other than the physician's primary practice location. Confirm how this disclosure rule applies to your advertising with the Texas Medical Board or a health care attorney.

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