Texas med spa licensing laws: Regulations, ownership, and scope of practice

Under Texas med spa licensing laws, you can run a med spa’s business side, but only a licensed physician can own its medical side. Whichever side you hold, our ranking of the top med spa software includes a pick for medical-director-led med spas.

That one rule is the Corporate Practice of Medicine doctrine. It shapes how you structure the company, who you appoint as medical director, and which staff can pick up a needle or a laser. Those treatments dominate the most common cosmetic procedures, with neurotoxins and fillers alone passing 15 million a year.

It also explains why first-time owners stumble. There is no single “med spa license” you apply for once. Instead, Texas med spa regulations come from four state agencies. They are the Texas Medical Board, the Texas Board of Nursing, the TDLR, and the Department of State Health Services. Federal HIPAA rules apply on top.

This guide pulls the Texas med spa licensing laws into one place, in plain English. It covers who can own a med spa, who regulates what, the delegation rules, who can perform each treatment, and the 2025 changes.

Key takeaways

In Texas, only a licensed physician (MD or DO) can own the medical side of a med spa, under the Corporate Practice of Medicine doctrine.

Texas has no single med spa license. The Texas Medical Board, the Texas Board of Nursing, and the TDLR each regulate a different part of the practice.

Since January 9, 2025, four Texas Medical Board rules govern delegation, covering training, signed protocols, written orders, and posted notices.

Each treatment depends on the provider’s license: physicians and delegated NPs, PAs, and RNs can inject, but an esthetics license covers only non-medical skincare.

Jenifer’s Law, in effect since September 1, 2025, covers only elective IV therapy, which a PA, APRN, or RN can give under physician supervision.

Who can own a med spa practice in Texas?

Texas follows the Corporate Practice of Medicine (CPOM) doctrine. It shapes California’s med spa licensing laws and most other states’ rules too. Only licensed physicians can own or control a medical practice, and that means an MD (Doctor of Medicine) or a DO (Doctor of Osteopathy).

Under CPOM and the Texas Medical Board’s enforcement, two rules stand out:

• Only a licensed physician may own or control a medical practice, med spas included.
• Non-physician entities, such as corporations, LLCs, or business owners who aren’t doctors, cannot hire or control physicians to provide medical services.

If your med spa offer botox, dermal fillers, laser treatments, or prescription-based procedures, Texas treats those as the practice of medicine, so they fall under physician supervision. Ownership then breaks down like this:

• A physician (MD or DO) owns and oversees the medical side of the business.
• Nurse practitioners (NPs), registered nurses (RNs), and physician assistants (PAs) cannot own or independently run a med spa that offers medical treatments. A nurse can still own the management company (MSO) that runs the business side, as our guide to Texas nurse ownership rules explains.
• PAs may hold a minority stake in some cases, but the physician keeps majority ownership and full control of medical decisions.

Non-physicians still play a vital role. For example, they can manage operations, marketing, or customer service. They just cannot make or influence medical decisions.

What happens if you set the structure up wrong?

The penalties are steep. A non-compliant structure can trigger license suspension, fines for unlicensed practice, or even forced closure.

A Travis County jury drove the point home with a $10 million verdict after a management company improperly controlled medical decisions. That case involved a hospital staffing arrangement, not a med spa, but the CPOM principle still applies.

Medical spa laws and licensing requirements in Texas

Once you know who can own a med spa in Texas, the next question is which approvals it needs to operate.

Is there a single medical spa license in Texas?

No. No single medical spa license authorizes a med spa on its own. Instead, you build a compliant med spa from several separate approvals, and the exact med spa requirements in Texas depend on the treatments you offer.

At a minimum, most medical spas need:

• A physician-owned entity, a PLLC or PA, to hold the medical practice under the Corporate Practice of Medicine doctrine.
• A licensed physician medical director to set protocols and supervise delegated care.
• An active state license for every provider who treats patients, from nursing to esthetics.
• Device registrations, such as registering Class 3B and 4 lasers with the Texas Department of State Health Services.
• HIPAA safeguards for patient records.

So when owners search for a medical spa license in Texas, the practical answer is simple. Compliance comes from stacking these pieces correctly, not from pulling one permit.

Who regulates med spas in Texas: TMB, BON, and TDLR

Three state agencies license the people and procedures in a Texas med spa. None of them is a “medical spa board,” because Texas doesn’t have one.

The Texas Medical Board (TMB) decides who can perform a cosmetic procedure and under what delegation, because performing one is legally practicing medicine. The Texas Board of Nursing (BON) enforces the Nursing Practice Act, Occupations Code Chapter 301. It sets what an RN, licensed vocational nurse (LVN), or advanced practice registered nurse (APRN) can do within that delegation. The TDLR licenses estheticians under Occupations Code Chapter 1603, plus laser hair removal professionals and facilities.

None of the three licenses substitutes for another. A TDLR esthetician license doesn’t authorize a medical procedure, and a TMB delegation doesn’t override the BON’s nursing scope. A fourth agency, the Department of State Health Services, registers the lasers themselves, as the next section covers.

Facility licensing and registration

Not every med spa in Texas needs a facility license, but certain treatments trigger registration.

The laser devices themselves must be registered with the Texas Department of State Health Services (DSHS), which handles radiation control. Each registration names a laser safety officer, whose duties are set out in 25 TAC §289.301.

That registration covers the devices, Class 3B and 4 lasers, whatever the treatment. Laser hair removal adds a separate layer. Since 2017, the Texas Department of Licensing and Regulation (TDLR), not DSHS, certifies laser hair removal facilities and the people who perform the procedure.

Health and Safety Code Chapter 401, Subchapter M, sets four certificate levels: apprentice-in-training, technician, senior technician, and professional. All four can perform the procedure. At a licensed facility, a certified Laser Hair Removal Professional, or a licensed health professional, must be present to supervise (§401.517).

To hold a laser hair removal facility license, a practice needs at least one certified Laser Hair Removal Professional. It also needs a written contract with a consulting physician who sets protocols and is available for emergencies (§401.519).

A physician-run med spa may not need a facility license at all. A facility owned or operated by a physician for the practice of medicine needs no facility license (§401.510(c)(1)). TDLR notes that a physician-owned site offering only laser hair removal still registers.

Physicians and their employees or delegates acting under Occupations Code Chapter 157 need no individual certificate (§401.504(d)). Nor does a licensed health professional working within their own board’s scope (§401.504(c)).

For other laser treatments, such as skin resurfacing or vascular lasers, the Texas Medical Board’s physician-delegation rules apply instead.

If the practice prescribes, stores, or administers controlled substances, such as ketamine or phentermine, the supervising physician needs a DEA registration. Botox and dermal fillers are not on the DEA controlled substance list, so they don’t trigger one.

The Texas Health Spa Act does not cover med spas

One mix-up is worth clearing up: the Texas Health Spa Act does not govern medical spas. That act, under Occupations Code Chapter 702, covers businesses that sell exercise-facility memberships. They register with the Texas Secretary of State and post a bond that protects members’ prepaid fees.

It is a consumer-protection law about membership contracts, cancellations, and refunds. It says nothing about who can inject Botox or run a laser.

The Texas Medical Board regulates a med spa that offers injectables or lasers as a medical practice. Unless you also sell fitness memberships, the Health Spa Act will not apply to you.

Medical director requirement

Every Texas med spa that provides medical treatments must have a licensed physician as its medical director.

A medical director’s duties usually include:

• Approving and updating treatment protocols.
• Delegating tasks to trained, qualified staff, such as NPs, RNs, or medical assistants, and supervising that work.
• Reviewing patient charts and treatment records to confirm proper care and documentation.

The physician does not have to be on-site every day, but they do have to stay actively involved in oversight and patient-care decisions.

Business entity setup

Texas’s Corporate Practice of Medicine (CPOM) laws mean you have to structure a med spa carefully.

The rule rests on two sections of the Texas Occupations Code. Section 155.001 bars anyone from practicing medicine without a Texas license. Section 164.052(a)(17) makes it a violation for a physician to aid or abet unlicensed practice, including practice by a corporation.

The clinical services run through a Professional Limited Liability Company (PLLC) or Professional Association (PA). Only licensed medical professionals can own those entities.

A separate LLC or Management Services Organization (MSO) handles the business and administrative side. That covers marketing, scheduling, payroll, or packaging services into profitable med spa packages. This lets non-physicians run the business without breaking medical-ownership rules.

The PLLC plus MSO dual-entity model is the standard structure Texas med spas use to keep medical oversight and business operations legally separate.

HIPAA compliance

Like any healthcare facility, a med spa must follow the Health Insurance Portability and Accountability Act (HIPAA) to protect patient privacy. That means securing patient data, keeping consultations confidential, and storing or transmitting records properly.

Non-compliance with HIPAA carries civil and criminal penalties, plus mandatory breach-notification requirements. Investing in compliant software, such as a HIPAA-compliant CRM, and in staff training keeps patient data protected and documented.

Staff licensing and certification

Every person who performs treatments in your med spa needs the right license for the service, or a physician’s delegation for a medical treatment.

Nurses who administer injectables need an active Texas nursing license. Estheticians need a license from the Texas Department of Licensing and Regulation (TDLR).

The four delegation requirements every Texas med spa must meet

Delegation is the core of Texas med spa regulation, and the Texas Medical Board rewrote the rule that governs it. On January 9, 2025, it repealed its old delegation rule, 22 TAC §193.17. Four new rules in 22 TAC Chapter 169, Subchapter E, took effect the same day.

Older guides that still cite §193.17 are out of date. Under the current rules, a med spa that delegates cosmetic procedures has to meet four requirements at once:

• Delegation is the practice of medicine (22 TAC §169.25). Nonsurgical cosmetic procedures, including cosmetic injections and prescription devices used for cosmetic purposes, count as practicing medicine. Each one traces back to a delegating physician.
• Training and a signed protocol (§169.26). The physician makes sure the person performing the act is trained in the technique, its contraindications, and its complications. That person signs and dates a written protocol.
• A written order the physician owns (§169.27). The physician either approves the business’s written order in writing or writes their own. It names the delegating physician and covers patient selection, appropriate care, and complications or emergencies.
• Notice and identification (§169.28). Every public area and treatment room shows the delegating physician’s name and Texas license number, plus the board’s complaint notice. Staff performing delegated acts wear a name tag showing their credentials.

Before treatment, a physician, or a PA or APRN under their delegation, must establish a practitioner-patient relationship and keep an adequate medical record. Many practices call this step the Good Faith Exam. The patient is also told who will perform the procedure and their title.

At least one person trained in basic life support must be present while the patient is on-site. A physician, PA, or APRN must be on-site too, or immediately available for an emergency consultation.

What happens when a med spa skips delegation

Skipping delegation puts more than one license at risk. The TMB can discipline the delegating physician for unprofessional conduct. It can also order an unlicensed person or business to cease and desist. The person who injected can be pursued for practicing medicine without a license.

A patient complaint often starts the review, and the §169.28 notice exists so patients know where to send one. Advertising gets the same attention. Claiming a credential a provider doesn’t hold is one red flag. Implying a nurse-run injection service needs no physician delegation is another.

Keeping the delegating physician’s name, license number, and complaint notice visible builds the paper trail. That record is what protects the practice when a patient does complain.

Who can perform med spa procedures in Texas?

Every role, from physician to esthetician, operates within a defined scope of practice. Here is who can do what in a Texas med spa at a glance, before we get into each role in detail:

Physicians (MD, DO)

In Texas, licensed physicians (MDs and DOs) have the broadest scope of practice for aesthetic medical procedures. Both hold full Texas practice rights, even though their training routes differ, as our MD vs DO comparison explains. They can perform virtually every treatment, from injectables and lasers to chemical peels and IV therapy.

Physicians also supervise every delegated procedure their staff perform. They write the protocols, review treatment plans, and hold responsibility for the care their team delivers.

Elective IV therapy has its own delegation list, limited to PAs, APRNs, and RNs. The Jenifer’s Law section below covers the details.

Nurse practitioners (NPs) and physician assistants (PAs)

Nurse practitioners (NPs) and physician assistants (PAs) can perform many popular med spa procedures, such as Botox, dermal fillers, and laser treatments. They work only under delegation from a supervising physician.

That delegation runs through a written agreement, a prescriptive authority agreement for an NP or a delegation and supervision agreement for a PA. It spells out their scope of practice, the standing protocols they follow, and how often the physician reviews charts. It also sets any limits on which procedures they can perform.

That agreement is the document that keeps the physician on the hook for all delegated tasks.

Registered nurses (RNs)

Registered nurses in Texas can also perform injectables, microneedling with PRP, and non-ablative laser treatments, but only under supervision.

The delegation always comes from a physician (MD or DO). BON Position Statement 15.11 adds that an APRN cannot re-delegate a medical act a physician delegated to them. An NP or PA can still establish the patient relationship and be the on-site or immediately available practitioner (22 TAC §169.26).

For lasers, Board of Nursing Position Statement 15.9 lets RNs perform laser therapy with a valid order and the right training. Its specific criteria cover non-ablative lasers, such as hair removal, so ablative resurfacing is widely read as outside nursing scope. RNs also cannot delegate any part of laser use to unlicensed staff.

However, RNs cannot diagnose patients or create treatment plans on their own. Their job is to carry out procedures safely within physician-approved guidelines.

Licensed vocational nurses (LVNs) and medical assistants

Licensed vocational nurses (LVNs) have a narrower scope. They cannot diagnose patients or prescribe treatment, because those acts need independent medical judgment.

Under Board of Nursing Position Statements 15.9 and 15.11, an LVN can carry out a delegated medical act, laser therapy included. The LVN needs documented training, a practitioner’s order, written procedures, and medical support on hand. Lasers also need an appropriate clinical supervisor, and Jenifer’s Law leaves LVNs off its list for elective IV therapy.

Medical assistants (MAs) play an essential support role, and Texas is more permissive here than many states. A physician can delegate non-surgical cosmetic procedures, including injections, to a properly trained MA.

First, though, a physician, PA, or APRN has to establish a relationship with the patient and record it. The MA then works from a signed protocol and a physician-approved written order, under supervision (22 TAC §169.25–169.28).

What an MA can never do is examine the patient, choose the treatment, or write that order. That part stays the practice of medicine.

Laser technicians and estheticians

Outside laser hair removal, Texas has no laser-technician license. The delegating physician must confirm each person’s training under 22 TAC §169.26. Laser hair removal staff need a TDLR certificate unless a §401.504 exemption applies.

You must register laser devices with the Texas Department of State Health Services (DSHS).

Estheticians hold a license from the Texas Department of Licensing and Regulation (TDLR). They can perform non-medical skincare, such as cleansing facials, exfoliation, masks, and light peels.

Their license never covers injectables, medical lasers, or microneedling, and no extra esthetics certification changes that. A physician can still delegate one of these acts to a trained esthetician, who then works as a delegate under 22 TAC §169.25–169.28.

How to become a medical esthetician in Texas

To become a medical esthetician in Texas, you complete a 750-hour esthetician program at a TDLR-licensed school. You then pass the state written and practical exams through PSI and hold an active esthetician license.

“Medical esthetician” is not a separate Texas license. It simply describes a licensed esthetician who works in a medical setting alongside clinical providers. The title does not widen your scope.

In practice, you can perform facials, exfoliation, superficial peels, and non-medical microdermabrasion. Your license never covers injectables, medical-grade lasers, or microneedling. You can perform one only as a trained delegate, under a physician’s written protocol and order.

How to set up a compliant med spa in Texas: Step-by-step

Put those requirements together and the setup follows a fairly predictable order. Here is how most compliant Texas med spas come together:

1. Form the clinical entity. Set up a physician-owned PLLC or PA to hold the medical practice. If a non-physician runs the business, pair it with a management services organization (MSO) under a written agreement.
2. Appoint your medical director. Bring on a licensed MD or DO to own the medical decisions, write the treatment protocols, and supervise delegated care.
3. License every provider. Confirm each clinician who treats patients holds an active Texas license for their role, from nursing to esthetics.
4. Register your devices. Register Class 3B and 4 lasers with DSHS, and secure a DEA registration in the supervising physician’s name if you will handle controlled substances.
5. Write it down. Put delegation in writing, set standing protocols, and build a Good Faith Exam into the patient flow before anyone delegates a treatment.
6. Post your disclosures. Display the delegating physician’s name and license number, plus the TMB complaint notice, in every public area and treatment room. Make sure delegated staff wear ID showing their name and credentials.

Before you treat your first patient: A compliance checklist

Run through this before you open, or before your next audit:

• Physician-owned PLLC or PA in place, with an MSO agreement if non-physicians are involved.
• A named medical director who reviews charts and stays reachable for emergencies.
• Signed written protocols and a physician-approved written order for every delegated treatment.
• A Good Faith Exam step built into the booking flow before treatment.
• Active licenses on file for every provider, with renewal dates tracked.
• Lasers registered with DSHS, plus a DEA registration if you use controlled substances.
• Delegating physician’s name, license number, and the TMB complaint notice posted, and staff ID badges showing credentials.
• HIPAA safeguards for records, consent forms, and before-and-after photos.

The right med spa scheduling software can enforce checklist steps like the Good Faith Exam automatically at booking.

Common mistakes that get Texas med spas in trouble

Most enforcement problems trace back to a handful of avoidable errors:

• A non-physician quietly steering medical decisions. An MSO can run the business, but the moment it makes clinical calls, you are back in Corporate Practice of Medicine territory.
• A “rented” medical director who never shows up. The physician must confirm each delegate’s training and stay reachable for emergencies (22 TAC §169.26). A name on the paperwork does neither.
• Skipping the Good Faith Exam. Delegating injectables or lasers is a serious slip if no physician, PA, or APRN has first established a relationship with the patient.
• Letting estheticians cross the line. Facials and superficial peels are fine. Microneedling, injectables, and medical-grade lasers fall outside an esthetics license.
• Running unregistered lasers. Register Class 3B and 4 devices with DSHS before you switch them on.

Texas med spa regulations: The 2025 changes in force for 2026

Even a well-organized setup has to keep pace with the rules, and Texas tightened them in 2025. Three developments still shape compliance in 2026: the rewritten Texas Medical Board rules, one new state law, and one bill that failed.

First, the rewritten Texas Medical Board delegation rules (effective January 9, 2025). They confirm that nonsurgical cosmetic procedures, including cosmetic injections, count as the practice of medicine. They also added the written protocol, written order, posting, and ID duties set out in the delegation section above.

Next, Jenifer’s Law (effective September 1, 2025). House Bill 3749 added a new Occupations Code chapter for elective IV therapy. Its scope is narrower than many owners assume, as the Jenifer’s Law section below explains.

Finally, the bill that did not pass. Senate Bill 378, nicknamed the “Botox party bill,” would have banned estheticians and cosmetologists from performing injections. However, Governor Abbott vetoed it on June 2, 2025, so it never took effect.

Even so, that opens no loophole. Injecting Botox or fillers without physician delegation was already illegal under Texas Medical Board rules, and it still is.

By 2026, the rules that passed are fully in force. In short, these are the Texas med spa laws most likely to change how you staff and document treatments.

Jenifer’s Law and elective IV therapy in Texas

Jenifer’s Law only regulates elective IV therapy given outside a physician’s office or a licensed health facility. It does not regulate med spas or cosmetic procedures broadly, which is narrower than much early reporting suggested.

The bill followed a patient’s death in July 2023 after IV therapy at a med spa in Wortham, Texas, per the bill analysis. Section 1 spells the short title “Jenifer’s Law,” with one n.

The bill as filed was broader, with medical-director and cosmetic-procedure provisions. The version Governor Abbott signed dropped them. It added Occupations Code Chapter 172, “Provision of Elective Intravenous Therapy,” effective September 1, 2025.

Under Chapter 172, a physician may delegate prescribing or ordering elective IV therapy to a PA or APRN under adequate physician supervision. The physician may delegate administering it to a PA, APRN, or registered nurse, under the same supervision.

LVNs, medical assistants, and other staff are not on that list. The chapter also excludes IV therapy given in a physician’s office, a licensed health facility, a licensed mental hospital, or a state hospital.

How Pabau helps Texas med spas stay compliant

Most of what keeps a Texas med spa compliant comes down to staying organized: current provider licenses, clear delegation, signed protocols, and clean patient records. That only gets harder as the schedule fills up.

Pabau handles the operational and documentation side of compliance in one system. That covers staff credentials, patient records, consent forms, and access controls:

• Track staff certifications and license renewal dates, so a lapsed license never slips past you.
• Set role-based permissions, so only qualified providers are booked for clinical tasks.
• Add a Good Faith Exam and consent step to the booking flow, so no delegated treatment starts without it.
• Keep consent forms, treatment notes, and before-and-after photos on one HIPAA-compliant patient timeline, ready to pull if the Texas Medical Board comes calling.
• Tie each treatment note to the provider who delivered it and the physician whose protocol covered it, so a TMB records request takes minutes.

Software will not replace legal counsel or the right entity structure, but it keeps the day-to-day paperwork that proves you are compliant in one place. See how Pabau can simplify your staff management. Dedicated medical spa software keeps licensing, delegation, and patient records aligned as the practice grows.

Keep Texas delegation records audit-ready

Pabau ties every treatment note to the provider who delivered it and the protocol they worked under. A TMB records request then never means digging through paper files.

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Conclusion

Every rule in this guide comes back to the same idea: medicine stays medicine, no matter who is holding the device or signing the form. A physician owns the medical side, a medical director sets the protocols, and every treatment traces back to a license whose scope includes it.

Get that structure right, and delegation, documentation, and device registration tend to fall into place around it.

One habit follows from that. Check the date on any guidance you rely on, because advice that still cites 22 TAC §193.17 predates the January 2025 rewrite.

A lapsed license or a missing consent form shouldn’t surface for the first time in an investigation. Book a demo to see how Pabau tracks staff credentials, consent, and compliance records day to day.

Continue your research

Who should run the medical side? Hiring a medical director walks through vetting, contracting, and defining the role before you open.

Wondering where HIPAA fits in? Med spa HIPAA compliance breaks down what HIPAA requires beyond a signed form.

Operating outside Texas too? California med spa laws show how differently the same questions get answered on the West Coast.

Still at the planning stage? Starting a med spa lays out the full launch sequence, from business plan to opening day.

Frequently asked questions