Texas Med Spa Compliance: The 2025 Regulatory Survival Guide

If you operate a medical spa in Texas, you are working in a state with some of the strictest corporate practice of medicine (CPOM) and supervision laws in the country. The regulatory environment is not getting easier; in fact, 2025 has brought significant changes that every owner, medical director, and injector needs to understand.

From new Texas Medical Board (TMB) rules that took effect in January to a strict new text message marketing law effective in September, the margin for error is shrinking.

This guide breaks down the critical compliance news you need to know to keep your license—and your business—safe in the Lone Star State.

1. The New TMB Rules: Supervision & Transparency

Effective Date: January 9, 2025

The Texas Medical Board has implemented a sweeping set of new rules designed to increase patient safety and transparency. These are not suggestions; they are requirements.

Key Changes You Must Implement Immediately:

• Mandatory Signage: You must now display signs in every treatment room and public area explaining how to file a complaint with the TMB. This sign must also list the name and license number of the supervising physician(s).
• ID Badges are Mandatory: Anyone performing a medical procedure under supervision (NPs, PAs, RNs) must wear a name tag with their name and credentials clearly visible.
• Emergency Availability: The supervising physician, PA, or APRN must either be on-site during the procedure OR be immediately available for an emergency consultation. The rule now allows PAs and APRNs to handle these emergency consults, providing some flexibility, but the physician must still be ultimately available if needed.

The Bottom Line: Patients must know exactly who is treating them and who is supervising that treatment. Anonymity is no longer an option.

2. The "Good Faith Exam" (GFE) is Non-Negotiable

In Texas, almost every aesthetic service—from Botox and fillers to laser treatments and IV therapy—is considered a medical procedure. This means a valid patient-provider relationship must be established before treatment begins.

• The Rule: A physician, PA, or APRN must conduct a "Good Faith Exam" to clear the patient for treatment.
• The Trap: RNs, estheticians, and medical assistants cannot perform the GFE. If an RN injects a new patient who has not been cleared by a mid-level or physician, it is a serious violation.
• Telehealth Solution: The good news is that Texas law allows this exam to be conducted via telehealth, provided it is a synchronous, live video consultation. This is a critical tool for maintaining compliance without having a physician in every room.

3. Ownership: The Corporate Practice of Medicine Doctrine

Texas has a very strict "Corporate Practice of Medicine" doctrine. This means that laypersons (non-physicians) cannot own a medical practice, and this includes medical spas.

• Who Can Own a Med Spa? Only a Texas-licensed physician can own the clinical side of the business.
• The MSO Model: Non-physician entrepreneurs can still participate through a Management Services Organization (MSO). In this structure, the physician owns the medical practice (PLLC or PA), and the non-physician owns a separate LLC that provides administrative services (marketing, payroll, staffing, real estate space) to the medical practice for a flat fee.
• The Warning: The physician must retain complete control over all clinical decisions, including hiring/firing of clinical staff and setting treatment protocols. The MSO cannot be paid a percentage of medical revenue, as this violates fee-splitting laws.

4. The New Marketing Minefield: SMS Texting Law

Effective Date: September 1, 2025

This is a sleeper law that could catch many practices off guard. Texas has expanded its telemarketing laws to include text and graphic messages.

What This Means:

If you send marketing texts (Botox specials, event invites, etc.), you may now be defined as a "telephone solicitor." This requires you to:

• Register with the Texas Secretary of State.
• Pay a filing fee.
• Post a $10,000 security bond.

The Critical Exemption: The law has an exemption for soliciting former or current customers. This means your existing patient list is likely safe to text, but buying a lead list and blast-texting them could land you in serious legal trouble, with penalties ranging from $500 to $5,000 per text message.

5. Advertising Pitfalls to Avoid

The TMB and Texas Attorney General aggressively police medical advertising.

• Truth in Advertising: You cannot make claims that are false, misleading, or deceptive. Avoid phrases like "risk-free" or guaranteeing specific results.
• Title Protection: Only licensed physicians can use the title "Doctor" or "M.D." in advertisements without clarification. Never imply that an RN or esthetician is a doctor.
• Before-and-After Photos: These must be representative of typical results. Using photos that are heavily edited or show extreme, outlier results can be considered deceptive.

Final Thoughts: Compliance as a Competitive Advantage

The regulatory landscape in Texas is designed to protect patient safety, but it also creates a barrier to entry. By understanding and strictly adhering to these rules, you protect your practice from fines and license revocation. More importantly, you build a reputation for professionalism and safety that will set you apart from competitors who cut corners.

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