Disclaimer: This material is provided for educational and informational purposes only. It does not constitute legal or medical advice or regulatory guidance. Requirements and interpretations may vary and change over time. Always verify current rules directly with the Texas Medical Board and the Texas State Board of Pharmacy and seek advice from qualified legal counsel before making decisions or taking action.
Executive Summary
- Only a Texas-licensed physician (MD/DO) can serve as the medical director for medical procedures. Nonphysicians can’t “practice medicine” or control medical decision-making. Most medspas use a physician-owned professional entity for the clinical side, plus a separate management services organization (MSO) for the business side.
- Physicians may delegate medical acts (including injectables and device use) to qualified staff and may delegate prescriptive authority to APRNs/PAs via a Prescriptive Authority Agreement (PAA). Outside specific exceptions, Texas caps prescriptive delegation at seven APRNs/PAs (FTE) per physician.
- Your PAA must be in writing and include defined drugs/devices, consultation/referral plans, communication processes, and quality assurance (including chart review and periodic meetings).
- Board rules were reorganized in 2025. The Texas Medical Board restructured its rules. The old §193.17 “nonsurgical cosmetic procedures” rule was retired; relevant delegation requirements now live under reorganized chapters. Keep current.
- A separate regime under TDLR governs laser hair removal facilities, technicians, supervision, and device purchase/usage—don’t confuse this with Medical Board rules.
- A 2025 bill (the so-called “Botox Party Bill,” SB 378) aims to clarify who can administer injectables and strengthen enforcement. Track status and effective dates.
Texas is one of the strictest states for medspas. Between the state’s Corporate Practice of Medicine doctrine (which limits who can own and control a medical practice), the Texas Medical Board’s rules on delegation and prescriptive authority, and separate, specialized regulations (like laser hair removal), it’s easy to miss a requirement that later turns into a board complaint or insurance headache.
This page brings the moving parts together—who can be a medical director, how collaboration works for NPs and PAs, what “delegation” really means, what you can and can’t do with injectables, and the structure most medspas use to stay on the right side of Texas law. Where it matters, we point you to the source statutes, rules, and state resources.
The Texas Quick Compliance Checklist
Entity & Ownership structure
Clinical care is delivered by a physician-owned professional entity; nonphysicians do not control medical decision-making. Your MSO agreement keeps operations (marketing, staffing, nonclinical assets) distinct from the practice of medicine.
Medical Director Credentials
Active, unencumbered Texas MD/DO license; familiar with cosmetic/aesthetic procedures offered; availability for supervision and QA as promised in contracts and policies.
Delegation & Prescriptive Authority
Written Prescriptive Authority Agreement (PAA) for every physician–APRNs/PAs pairing that prescribes; PAA includes drugs/devices permitted, consultation/escalation rules, QA plan with chart review volume, and periodic meetings (documented). Track the seven FTE cap on delegated prescriptive authority (unless you qualify for exceptions like facility-based practice or medically underserved settings).
Track the seven FTE cap on delegated prescriptive authority (unless you qualify for exceptions like facility-based practice or medically underserved settings).
Scope of Practice Mapping
Written matrix of who may do what (MD/DO, NP, PA, RN, LVN, laser tech, aesthetician), tied to statutes/rules and the physician’s delegation policies. Texas Medical Board
Informed Consent & Protocols
Procedure-specific policies (Botox/fillers, energy devices, microneedling, chemical peels, thread lifts, IV therapy, etc.), complications playbooks, emergency meds, and escalation routes. (Align with TMB delegation and QA expectations.) Texas Medical Board
Laser Hair Removal Compliance
If you offer laser hair removal, confirm TDLR facility registration, technician certifications, supervising/consulting physician contract, and device prescription/order requirements. TDLR+1
Marketing & Representation
Ads don’t imply independent practice by nonphysicians; titles are accurate (no “doctor” for nonphysicians). Offers avoid implying that cosmetologists/estheticians perform medical procedures. (Track SB 378 changes.) Texas Medical BoardMySA
Quality Assurance Cadence
Monthly or as-needed chart reviews, adverse event tracking, medication/device logs, and standing orders/protocol updates. (Your PAA’s QA plan should specify numbers and meeting frequency.) Texas.Public.Law
Recordkeeping & Access
Maintain PAAs, delegation memos, training logs, competency check-offs, laser logs, and incident reports; verify off-site access for the medical director to review records. Texas Medical Board
Change Management
When you add a new modality (e.g., RF microneedling), update scope matrices, consents, training, and PAA references; notify the medical director and re-train affected staff. Texas Medical Board
The Legal Frame: CPOM + Who Can Be a “Medical Director”?
Who Can Be a Medical Director in Texas?
Why a “Nonphysician Medical Director” Isn’t a Thing in Texas?
Collaboration & Delegation: NPs and PAs in a Texas Medspa
Texas draws a clear line between collaboration and independent practice for APRNs/PAs. In aesthetics, here’s how it plays out:
- Prescriptive Authority: A physician may delegate prescriptive authority to an APRN/PA via a Prescriptive Authority Agreement. The PAA must be written, signed, and include specific elements—practice settings, drugs/devices authorized or excluded, emergency plans, consultation/referral pathways, and QA (chart review + meetings).
- Seven-FTE Limit: Outside defined exceptions, Texas caps prescriptive delegation at seven APRNs/PAs (or the FTE equivalent) per physician. The cap is about prescriptive authority, not general supervision headcount. Facility-based practices and underserved settings can exceed the cap.
- Day-to-Day Delegation: Separate from prescribing, physicians may delegate medical acts if they ensure adequate supervision and the delegate is qualified by training and licensure. In aesthetics, that usually means written protocols for injectables, laser/energy device parameters, and complication management.
Practical Tips That Survive Audits
Don’t bury your QA plan. Surveyors and investigators tend to ask, “Show me your PAA, the last three chart reviews, and the sign-in sheet for your monthly review meeting.” If it takes 20 minutes to find, you’ve already lost points.
Injectables and Device Procedures: What “Legal” Looks Like in Practice
Injectables (e.g., OnabotulinumtoxinA/Botox®, Fillers)
- Considered medical procedures in Texas, they require medical oversight and appropriate delegation. Your protocols should specify patient selection, contraindications, dosing ranges, lot/expiry documentation, post-procedure instructions, and complication plans (e.g., anaphylaxis, vascular occlusion).
- Who may inject? Clinically qualified personnel acting under physician delegation (often MD/DO, NP, PA, or RN with competencies). Estheticians and cosmetologists are not permitted to perform medical procedures. A 2025 bill (SB 378) seeks to codify and tighten enforcement for unauthorized injections; monitor the effective date and details.
Lasers, IPL, and Energy Devices
- For laser hair removal, Texas runs a separate licensing system under TDLR—covering facility registration, technician certifications (Apprentice-in-Training → Technician → Senior → Professional), approved training entities, and supervision arrangements. Device acquisition typically requires a physician’s order; TDLR’s FAQ explains the consulting physician role and prescription requirement for devices.
- For other devices (RF, IPL, ablative lasers), look to the Medical Board’s delegation standards and your medical director’s protocols; ensure the operator’s license and training match the device’s risk profile.
Microneedling, Peels, Threads, IV Therapy
- Build procedure-specific checklists and consent forms. Many of these are medical acts when they cross into deeper tissue, use prescriptive devices/solutions, or carry medical risk; they should be covered under physician delegation with documented training and QA.
The Paperwork Texas Actually Expects to See
When a complaint, audit, or payer review happens, you’ll be asked for documents, not good intentions. Keep a clean “compliance binder” (digital is fine) with:
- Entity Documents: Professional entity formation for the clinical practice; MSO agreement (showing no lay control of medical decisions). Texas Medical Association
- Licenses & Credentials: Medical director license, DEA (if applicable), APRN/PA licenses, RN/LVN licenses, TDLR laser credentials, facility registration. TDLR
- PAAs: For each APRN/PA with prescriptive authority. Include the drugs/devices list, consultation/referral plan, emergency plan, QA plan, and designated alternate physicians if used. Keep meeting notes and chart review logs aligned with the QA plan. Texas.Public.Law
- Delegation Memos & Protocols: Who performs which procedures; competency checklists; device parameter sheets; crash cart contents; complication algorithms. Texas Medical Board
- Laser Hair Removal File: Facility registration, technician certificates, consulting physician agreement, device order/prescription, treatment logs. TDLR
- Marketing Approvals: Sign-off showing medical director review where claims touch clinical care; proof you don’t advertise unlawful scope (e.g., estheticians injecting). Track SB 378 updates. MySA
Common Pitfalls We See (and How to Avoid Them)
- Assuming an RN can be a “medical director.”
They can be extremely valuable clinical leaders, but in Texas, the legal “medical director” must be a physician. Build accurate titles and org charts. Texas Medical Association - Confusing “seven-provider cap” with supervision in general.
The cap applies to prescriptive delegation, not to general oversight of staff. Still, don’t overextend your physician; quality and availability matter to the Board. Texas Medical Board - Stale PAAs and missing QA proof.
A beautifully written PAA isn’t enough if you can’t show that meetings and chart reviews actually happened. Put QA on the calendar and keep sign-ins/minutes. Texas.Public.Law - Laser hair removal is treated like a spa add-on.
It’s a regulated service under TDLR with facility/tech requirements and physician involvement. Don’t launch before paperwork and training are complete. TDLR - Advertising that implies unlicensed practice.
If your social posts or landing pages imply that estheticians inject or that the business controls medical decisions, you’ve created evidence against yourself—and SB 378 is poised to tighten enforcement. MySA
FAQs
When a complaint, audit, or payer review happens, you’ll be asked for documents, not good intentions. Keep a clean “compliance binder” (digital is fine) with:
Can a nonphysician own my medspa?
Yes, but not the medical practice. Use an MSO for business operations while the physician-owned professional entity delivers medical care and retains medical control. Texas Medical Association
How many APRNs/PAs can one physician give prescriptive authority to?
Generally, seven FTEs across APRNs and PAs combined, with exceptions for facility-based practice and some medically underserved settings. Track your ratios. Texas Medical Board
Do my PAAs have to list every drug and device?
They must at least identify categories of drugs/devices that are authorized or excluded, and outline consultation/emergency plans, communication, and QA (chart review + meetings). Many clinics also attach a formulary sheet and device list for clarity. (Texas.Public.Law)
Are estheticians allowed to perform microneedling or lasers?
It depends on depth, device, and whether the act constitutes the practice of medicine. For laser hair removal, you must follow TDLR’s licensing/certification framework and physician involvement rules; other energy devices fall under Medical Board delegation standards. (TDLR, Texas Medical Board)
What changed in 2025 with the Medical Board rules?
The Board reorganized and consolidated rules—prior §193.17 (nonsurgical cosmetic procedures) was folded into a broader delegation framework. Always read the current Board rules page to map your policies to the right sections. (Texas Medical Board, American Med Spa Association)
What’s the status of the “Botox Party Bill”?
In 2025, SB 378 advanced with an effective date targeted for September 1, 2025, if fully enacted; it clarifies who may administer injectables and increases enforcement options (including TDLR’s role). Keep watching the final enactment language and implementation guidance. (MySA)
Templates and Operational Playbooks (What to Implement This Week)
Use these to build internal SOPs. They mirror what investigators often ask to see.
PAA Master Template
Parties, sites, scope of drugs/devices (authorized/excluded), consultation/referral, emergency care, QA plan with chart review volume and meeting cadence, alternates, and documentation method.
Delegation & Scope Matrix
Columns: Procedure | Who May Perform | Prereqs (license/training hours) | Who May Inject/Operate | Physician Availability | Complication Plan Document.
Monthly QA Pack
Use these to build internal SOPs. They mirror what investigators often ask to see.
Meeting agenda and minutes; chart review list with findings and remediations; device maintenance logs; adverse event review; protocol changes approved by the medical director.
Laser Hair Removal Binder (TDLR)
Facility registration, technician credential ladder, consulting physician contract, device purchase order/prescription, treatment logs, CE compliance.
Marketing Compliance Checklist
Title usage, claims review, required disclosures, “who performs what” language, photo/video guardrails; SB 378 status check before campaigns.
Building a and Defensible Structure (the MSO + PC model)
Most Texas medspas that aren’t physician-owned use a dual-entity configuration:
- A physician-owned professional entity (PC/PLLC) employs or contracts the clinicians, owns medical records, decides clinical protocols, and bears clinical risk;
- A nonphysician-owned MSO provides management services—space, staff, marketing, billing support—without controlling medical decision-making.
The Texas Medical Association’s CPOM whitepaper explains why this matters, where it trips people up, and what penalties look like when lines blur. If you do nothing else this month, read it and align your contracts and day-to-day decision rights to it. Texas Medical Association
Implementation Plan (30/60/90 Days)
Days 1–30: Foundation & Paperwork
- Inventory licenses (MD/DO, APRN/PA, RN/LVN, laser tech), PAA status, and laser facility registration. Close all gaps first.
- Consolidate protocols, consent forms, and medication/device logs; align your scope matrix to Board rules.
- Run a “seven-FTE cap” reconciliation for each physician’s prescriptive delegation. Document any facility-based or underserved exceptions.
Days 31–60: QA in Action
- Start monthly QA meetings and chart reviews per PAA (don’t over-promise; choose a number you’ll hit consistently).
- Conduct a mock inspection for TDLR (laser) and a separate mock for TMB delegation/QI.
- Refresh marketing: scrub copy and creative so no one could infer unlicensed practice; add medical director oversight language. Track SB 378 status.
Days 61–90: Risk Hardening & Growth
- Train injectors and device operators using competency checklists tied to your protocols; log completion and direct observation sign-offs.
- Audit your MSO agreement and governance (meeting minutes, policy approval trails) to show the physician controls medicine.
- Create a one-page public Compliance Statement (site footer) linking to your medical director bio and patient safety practices.
How Medical Director Co. Supports Texas Medspas
Running a compliant medspa in Texas isn’t just about hiring a physician and checking boxes. The rules are complex, and they keep changing. That’s where Medical Director Co. comes in. We’re built specifically for aesthetics practices that need a licensed Texas physician to act as medical director while also providing the systems and documentation regulators expect.
Here’s what we provide:
Access to Qualified Texas Physicians
- We connect you with board-certified, Texas-licensed MDs and DOs who understand the aesthetics industry.
- Each physician is vetted for experience with injectables, energy devices, and cosmetic procedures so they can delegate appropriately and confidently.
Turnkey Prescriptive Authority Agreements
- Our team provides templates tailored to Texas law that outline required elements: drugs/devices covered, consultation and referral processes, emergency protocols, and quality assurance (QA) plans.
- We help you keep these agreements updated when new services or providers are added.
Ongoing Quality Assurance Support
- We set up your monthly chart review cadence, QA meetings, and documentation logs, so you can show proof of compliance if the Board ever asks.
- Our system makes it easy for medical directors to sign off on reviews remotely while keeping an auditable trail.
Laser Hair Removal Compliance
- If you offer laser services, we guide you through TDLR facility registration, technician certification, and consulting physician agreements so you’re covered on both the Medical Board and TDLR fronts.
Business & MSO Alignment
- Many Texas medspas use a dual-entity model (a physician-owned professional entity for clinical care and a management services organization for business operations).
- We help you structure this properly so the physician retains medical control, while your MSO handles marketing and operations—keeping you safe under the Corporate Practice of Medicine Doctrine.
Updates on Changing Laws
- With new legislation like the 2025 “Botox Party Bill” (SB 378) tightening rules on injectables and supervision, we monitor changes and update your protocols before they become compliance problems.
Medical Director Co. gives Texas medspas more than just a name on paper. We provide the licensed physicians, the agreements, and the compliance infrastructure you need to operate legally, reduce liability, and grow without fear of regulatory surprises.
Areas We Serve
Texas Resources You Should Bookmark
Blaz Korosec is the CEO and co-founder of Medical Director Co., a nationwide platform that connects aesthetic and wellness professionals with licensed physicians for medical oversight, supervision, and compliance support. With a background that bridges healthcare operations, regulatory compliance, and entrepreneurial growth, Blaz has worked closely with hundreds of nurses, physician assistants, and clinic owners to help them legally launch and scale medical spas, telehealth weight loss clinics, IV hydration businesses, and aesthetic practices.
Blaz holds a degree in finance from Southern Methodist University (SMU) and has built a diverse portfolio of businesses ranging from healthcare to hospitality, including a national network of RV parks and medical clinics. Through MedicalDirector.CO, he’s developed a deep understanding of the state-by-state rules that govern collaborative agreements, PC/MSO structures, telemedicine protocols, and injectable treatments—translating complex legal frameworks into easy-to-implement solutions for clinicians and business owners.
Blaz is particularly passionate about helping nurses and mid-level providers unlock business ownership opportunities, and he’s known for designing systems that streamline operations, boost revenue, and ensure long-term legal protection. His team includes former prosecutors, senior RNs, and physicians who together support a growing number of clinics across all 50 states.
When he’s not working, Blaz enjoys mountain biking, restoring properties, and exploring the outdoors with his wife. He’s based in Texas but works with clients nationwide.
