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“... credit for one hour of formal ethics CME for TMB registration requirements.TMB Announcement for 2024 Outreach
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“... plus New Licenses!
NEW Physician Fingerprinting Renewal Requirement
ALERT – Scams Targeting DEA Registrants & Other Health Professionals
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Our mission is to protect and enhance the public's health, safety and welfare by establishing and maintaining sta ... ”
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“... in 3 business days by agency staff.
Registration/Renewal questions:
For questions or information related to the registration/renewal or verification of a license, permit or certificate, MyTMB access, CME audit or registration of prescriptive delegation, please include your name and lic ... ”
“... a postcard within 2 weeks of being licensed, with registration instructions.
Important Things to Know!
Completing Stage 1 (Pre-Licensure) does not mean you are eligible for licensure. Only after you complete Stage 2 (Licensing) are you ready to be licensed.
Visit LIST, as often as ... ”
“... Jurisprudence (JP) exam and complete the initial registration of my new license?
The JP exam is available to take online through your “My TMB” account. The JP exam must be completed before you can complete your initial registration. Both completion of the JP exam and the initial registr ... ”
“... ist - PDF
IMLC New Licensee Information
IMLC Renewal Information
License Issue dates
IMLC FAQs ”
“... ister his or her license with the Board and pay a registration fee. You must complete the JP exam, initial registration, and pay the fee within 90 days of the date your license was issued to avoid penalty fees.
Step 1 - Create a MyTMB Account - (required to take JP exam)
Step 2 - ... ”
“... r the first time, you need to pay your first time registration fee within 90 days of your license issue date. To maintain an active license you will need to renew your registration biennially.
At this time, initial Acupuncture registration may not be completed online. Acupuncturis ... ”
“The retired status exempts physicians from the registration process, registration fee, and CME.
The following restrictions apply to physicians whose licenses are on retired status:
the physician cannot engage in clinical activities or practice medicine in a Texas, and
to be eligible for reti ... ”
“Physician Online Registration
PA Online Registration
AC Online Registration
NCT Online Registration
Delegation Online Registration ”
“... and after one year, license cancellation.
Initial registration is completed via hardcopy forms sent to the licensee shortly after issuance. Subsequent renewals are currently completed on hardcopy forms as well.
Please note: You must complete registration and pay the fee within 90 days o ... ”
“... r the first time, you need to pay your first time registration fee within 90 days of your license issue date. To maintain an active license, you will need to renew your registration every two years.
Currently Surgical Assistants are not able to register online. Registration forms will be sent ... ”
“The biennial registration fee includes a $2 Office of Patient Protection fee. These fees are required by statute. The remaining $555 is the fee required by the TMB.
These fees are explained in more detail in the chart below.
Subsequent Registration
Length of Permit
Agency Fee
O ... ”
“Delinquency fees
Initial Registration – If you have not registered your license within 90 days of your license issue date, a penalty fee equal to ½ the registration fee will be assessed. If you have not registered your license within 120 days of your license issue date, the ... ”
Description: Rule Changes December 23, 1997
Document: ... ensure by fifth pathway. Chapter 166.2, Physician Registration amendment to clarify which CME courses involving the study of medical ethics and/or professional responsibility are recognized by the board to be in compliance with CME requirements. Chapter 174.16, Telemedicine new section outlining req ...
Description: Rule Changes December 4, 2011
Document: ... ation and Administrative Fees; §175.2, concerning Registration and Renewal Fees; and §175.5, concerning Payment of Fees or Penalties, without changes to the proposed text as published in the October 7, 2011, issue of the Texas Register (36 TexReg 6615) and will not be republished. The amendment to § ...
Description: Rule Changes November 30, 2009
Document: ... e requirement of presentation of a certificate of registration in relation to foreign medical school graduates since the Board obtains other documentation from applicants to demonstrate graduation from medical school; §163.6, relating to Examinations Accepted for Licensure, allows for more than thre ...
Description: Rule Changes November 30, 2003
Document: ... 8 of the 78th Legislature. Chapter 166, Physician Registration. Amendments to §§166.1-166.6 regarding biennial registration as mandated by Senate Bill 104. Chapter 171, Postgraduate Training Permits. Amendments to §171.2 regarding qualifications for postgraduate permit holders and temporary permits. ...
Description: Rule Changes November14, 2000
Document: ... fication applications and office-based anesthesia registration. Chapter 186, Supervision of Physician Assistant Students - rule review and extensive rewrite of the chapter. Chapter 192, Office-Based Anesthesia - proposed amendments to §192.4 regarding site-based registration. Chapter 193, Standing D ...
Description: Rule Changes September 28, 2006
Document: ... lties, and Forms, to include amendments to 175.2, Registration and Renewal Fees, regarding Texas Online fees for office-based anesthesia, and new 175.5, Payment of Fees or Penalties regarding the form of payment accepted for fees and penalties. Chapter 179, Investigations, new 179.8, providing for a ...
Description: Rule Changes September 27, 2007
Document: ... ic Technicians, amending 194.2 Definitions; 194.3 Registration; 194.4 Annual Renewal; 194.5 Non-Certified Technician s Scope of Practice; 194.6 Suspension, Revocation or Nonrenewal of Registration. Provides updates regarding the names of the Texas medical Board and Department of State Health Service ...
Description: Rule Changes September 21, 2009
Document: ... ecialists, which establishes that application and renewal fees for acudetox specialists are provided under Sections 175.1-175.2 of title 22 of the Administrative Code. http://www.sos.state.tx.us/texreg/archive/September182009/adopted/22.EXAMINING%20BOA RDS.html#182
...
Description: Rule Changes September 21, 2000
Document: ... the complete board rules. Chapter 166, Physician Registration -- amendment to §166.2, regarding penalty fee for action taken relating to failure to obtain CME. Chapter 183, Acupuncture - re-write of chapter. Chapter 185, Physician Assistants - re-write of chapter, including substantial changes rega ...
Description: Rule Changes September 19, 2002
Document: ... ral clean-up of the rules. Chapter 166, Physician Registration. Amendment to '166.2 relating to CME hours obtained during the 30-day grace period, audit of CME and CME temporary permit. Chapter 171, Postgraduate Training Permits. Rule review of the chapter no changes. Chapter 173, Physician Profile ...
Description: Rule Changes September 18, 2011
Document: ... : Amendment to §175.1 raises the fees for initial registration to be a non-certified radiologic technician (NCT) to $115.50 to be consistent for the fees for renewals of NCT certificates and increases the application fees $10 each for initial physician in training permits, physician in training perm ...
Description: Rule Changes September 12, 2004
Document: ... to §175.1 related to increases in application and registration fees mandated by the Texas Online Authority and increase in physician-in-training fee relating to the length of the permit. Chapter 183, Acupuncture. Amendments to §§183.2 and 183.16 clarifying that certificates and diplomas are acceptab ...
Description: Rule Changes September 10, 2009
Document: ... ication fees to cover the agency's costs; §175.2, Registration and Renewal Fees, to increase certain registration and renewal fees to cover the agency's costs, and establish a charge for the review of continuing acupuncture education courses on a per course basis; and §175.5, Payments of Fees or Pen ...
Description: Rule Changes August 20, 2009
Document: ... than mandatory for each applicant; §185.6, Annual Renewal of License, allows physician assistants to obtain six hours of continuing medical education (CME) per year by serving as an expert panel reviewer for the Board and deletes language relating to a 30-day grace period after expiration of license ...
Description: Rule Changes August 10, 2008
Document: ... in the active practice of medicine. Chapter 166, Registration, with amendments to §166.1, Physician Registration, updates rule to conform with biennial registration; §166.2, Continuing Medical Education, updates rule to conform with biennial registration and amends provisions related to administra ...
“... he physician's practice of medicine is in any way controlled or directed by, or fees shared with a non-physician. Generally, physicians may enter into independent contractor arrangements with non-physicians. However, whether an independent contractor situation exists is a question of law and attenda ... ”
What is the "corporate practice of medicine"?
The corporate practice of medicine is a legal doctrine, which generally prohibits corporations, entities or individuals (i.e. non-physicians) from practicing medicine.
A general summary of the corporate practice of medicine doctrine is that it prohibits physicians from entering into partnerships, employee relationships, fee splitting, or other situations with non-physicians where the physician's practice of medicine is in any way controlled or directed by, or fees shared with a non-physician. Generally, physicians may enter into independent contractor arrangements with non-physicians. However, whether an independent contractor situation exists is a question of law and attendant facts.
Section 165.156 of the Medical Practice Act makes it unlawful for any individual, partnership, trust, association or corporation by use of any letters, words, or terms, as an affix on stationery or advertisements or in any other manner, to indicate the individual, partnership, trust, association or corporation is entitled to practice medicine if the individual or entity is not licensed to do so.
Section 164.052(a)(13) of the Medical Practice Act authorizes disciplinary action against any licensee for impersonation of a licensed practitioner or permitting another to use his license to practice medicine. Section 164.052(a)(17) authorizes disciplinary action against a practitioner for aiding or abetting, directly or indirectly, the practice of medicine by non-licensed individuals or entities.
Beginning in 2011, the Texas Legislature enacted laws authorizing certain types of hospitals and specific hospital districts to directly hire physicians.
Because of the highly technical aspects of this doctrine, a physician should consult with private counsel regarding any actual or contemplated arrangement. Please be advised that the Board staff is not authorized to provide private legal advice.
The following case law/legal authority may be helpful in the analysis and are available from any local law library or private counsel:
a. Garcia v. Texas State Board of Medical Examiners, 384 F.Supp. 434 (W.D. Texas 1974);
b. F.W.B. Rockett v. Texas State Board of Medical Examiners, 287 S.W.2d 190 (Tex. Civ.App.- San Antonio 1956, writ ref'd n.r.e.);
c. Watt v. Texas State Board of Medical Examiners, 303 S.W.2d 884 (Tex. Civ. App.- Dallas 1957, writ ref'd n.r.e.);
d. Flynn Brothers, Inc. v. First Medical Associates, 715 S.W.2d 782 (Tex. Civ. App.- Dallas 1986, writ ref'd n.r.e.)
e. Woodson v. Scott & White Hospital, 186 S.W.2d 720 (Tex. App. 1945, writ ref'd w.o.m.)
f. Tex. Atty. Gen. Op. JM-1042 (1989)
g. Tex. Atty. Gen. Op. WW-278 (1957).
h. Tex. Atty. Gen. Op. JM 369 (1985)
i. Tex. Atty. Gen. Op. DM-138 (1992)
j. Tex. Atty. Gen. Op. M-551 (1970)
k. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, section 162.001.
l. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, section 162.001.
m. The Medical Practice Act, Texas Occupations Code Annotated, Title 3, Subtitle B as amended, 151.055.
n. Occupations Code, section 102.001.
“... ngerprint results will not be REQUIRED until your renewal. Fingerprinting for physicians began with the February 2024 expiration dates. Licensees will receive advance notice from the TMB of when they should begin the process. ”
When do we have to do it?
Fingerprint results will not be REQUIRED until your renewal. Fingerprinting for physicians began with the February 2024 expiration dates. Licensees will receive advance notice from the TMB of when they should begin the process.
“... litary veteran. There is no current reduced registration fee. ”
Is there a reduced fee for military applicants?
Senate Bill 807, effective on 9/1/2015, allows for the waiver of application fees for any military service member, military spouse or military veteran. There is no current reduced registration fee.
“... quired for initial licensure in Texas but not for renewal of an active Texas Physician Assistant License. ”
Does Texas require NCCPA Certification?
NCCPA Certification is required for initial licensure in Texas but not for renewal of an active Texas Physician Assistant License.
“... ation fee does not cover any part of your initial registration. ”
What other fees may I have to pay besides the $817 physician application fee?
Fees are typically required from other institutions that provide documents or services - such as the FSMB for the FCVS packet, or exam transcripts; the NPDB/HIPD for their reports, FCSA for a foreign education evaluation; the jurisprudence exam which is administered by PearsonVue; and the criminal history background check. Finally, the application fee does not cover any part of your initial registration.
“The Board assigns the first registration period. These vary in length from 12 to 24 months. First time registration fees are prorated accordingly:Initial Registration Fee prorated amounts, as of 9/1/2023:Initial registration of 12 months - $283.48Initial registration of 24 months - $469.48 ... ”
What is the initial registration fee for my physician license?
The Board assigns the first registration period. These vary in length from 12 to 24 months. First time registration fees are prorated accordingly:
Initial Registration Fee prorated amounts, as of 9/1/2023:
Initial registration of 12 months - $283.48
Initial registration of 24 months - $469.48
“... gned and processed. This fee does not include the registration fee, which is due and payable upon issuance of your permanent license. ”
What is the fee to apply for a physician license?
As of 9/1/2015, the fee for physician licensure in Texas is $817.00. The entire fee must be submitted before your application can be assigned and processed. This fee does not include the registration fee, which is due and payable upon issuance of your permanent license.
“Yes. The completed registration application and payment are due on or before the expiration date of the permit. However, you should allow at least 5 working days for the processing of the form, the fee and posting to the computer system. ”
Is the registration payment due before the expiration of a license?
Yes. The completed registration application and payment are due on or before the expiration date of the permit. However, you should allow at least 5 working days for the processing of the form, the fee and posting to the computer system.
“Refunds of application/registration fees are available in very limited circumstances. These fees may be refunded in cases of administrative error by the TMB; applicants who withdraw their applications within 45 days of initial application, licensees who retire or request cancellation within 90 days ... ”
Can fees be refunded?
Refunds of application/registration fees are available in very limited circumstances. These fees may be refunded in cases of administrative error by the TMB; applicants who withdraw their applications within 45 days of initial application, licensees who retire or request cancellation within 90 days of paying the fee, or on behalf of applicants/licensees who die within 90 days of paying the fee. A pro-rated refund may be requested for good cause by a spouse or personal representative of an applicant/licensee who has died more than 90 days after paying the application/registration fee.
“... lected in a random CME audit conducted after each registration period or if you receive a written request from Board staff to present these documents. ”
Do I need to send copies of my CME certificates with my registration?
No. You will need to provide these documents if you are selected in a random CME audit conducted after each registration period or if you receive a written request from Board staff to present these documents.
“... ver, military personnel, with questions regarding registration or permits, who are being deployed, should contact the TMB. ”
Is there a reduced fee for military licensees?
No, there is not. However, military personnel, with questions regarding registration or permits, who are being deployed, should contact the TMB.
“... license is delinquent or suspended at the time of registration) the additional processing fee will not be required. ”
Is it the same price to register online or by hard copy?
No. An additional processing fee of $50 will be charged to those licensees who choose to register through a hard copy form, when an online option is available. If an online option is not available (ex: license is delinquent or suspended at the time of registration) the additional processing fee will not be required.
“... ubmit a written request on letter head. Once your registration as an HCE has been verified, a letter will be sent to the address and contact of record with the username and/or password information.You may submit your written request to: Texas Medical Board Attn: HCE Registration MC-263, P.O. Box 201 ... ”
How do I retrieve my username and/or password for the HCE verification system if I lost it?
If you are not able to locate your username and password, please submit a written request on letter head. Once your registration as an HCE has been verified, a letter will be sent to the address and contact of record with the username and/or password information.You may submit your written request to: Texas Medical Board Attn: HCE Registration MC-263, P.O. Box 2018 Austin, Texas 78768-2018
“... for the contact update on letter head. Once your registration as an HCE has been verified, a letter will be sent to the address and contact of record with the username and/or password information. You may submit your written request to: Texas Medical Board Attn: HCE Registration MC-263, P.O. Box 20 ... ”
How do I update the contact name for my registered HCE for the verification system?
Please submit a written request for the contact update on letter head. Once your registration as an HCE has been verified, a letter will be sent to the address and contact of record with the username and/or password information. You may submit your written request to: Texas Medical Board Attn: HCE Registration MC-263, P.O. Box 2018 Austin, Texas 78768-2018
“... the ability to order and prescribe dangerous and controlled substances to patients for anesthesia and anesthesia-related services. Under section 157.058, a CRNA pursuant to the physician’s order and in accordance with facility policies or bylaws may select, obtain, and administer those drugs ... ”
What are the general rules related to AAs/CRNAs?
The authority to delegate is found in Chapter 157 of the Texas Occupations Code, and Title 22 of the Texas Administrative Code, Section 193. A physician is allowed to delegate certain duties to a qualified and properly trained person acting under the physician’s supervision:
1) if in the opinion of the delegating physician the act can be properly and safely performed by the person to whom the medical act is delegated;
2) the act is performed in its customary manner; and
3) the performance of the act by the delegate is not in violation of any other statute.
It is clear that AAs can be delegated certain tasks under Chapter 157. The question is the extent allowable of such delegation. The key provision that needs to be examined is likely “not in violation of any other statute.”
Although the Nursing Act describes what a CRNA can do in regard to anesthesia, there is overlap of regulation of CRNAs between the Medical Board and Nursing Board. CRNAs are subject to physician delegation under the Medical Practice Act. The delegating physician can limit what a CRNA is allowed to provide under a Prescriptive Authority Agreement (PAA) or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
The level of supervision required for any AA (or any delegated provider) is determined based on training, knowledge, and experience, as determined by the physician. For CRNAs, whether any level of physician supervision is required will depend upon those same factors, in addition to applicable federal and state statutes, regulations, bylaws, and ethical standards, if any. However, AAs and CRNAs cannot practice independently and require physician delegation. A hospital or facility can set their own standards, policies, etc., related to delegation and supervision as long as it does not violate Chapter 157, board rules, or other applicable federal and state statutes and regulations. Although AAs most commonly work under an anesthesiologist physician, any physician may supervise and delegate to AAs; however, the standard of care must be met and the delegating physician remains responsible for the AA’s actions.
One difference between an AA and CRNA is the ability to order and prescribe dangerous and controlled substances to patients for anesthesia and anesthesia-related services. Under section 157.058, a CRNA pursuant to the physician’s order and in accordance with facility policies or bylaws may select, obtain, and administer those drugs appropriate to accomplish the order. The physician’s order for anesthesia or anesthesia-related services is not required to specify a drug, dose, or administration technique.
As previously stated, the Nursing Act describes what a CRNA can do in regard to anesthesia. However, the delegating physician or facility can limit what a CRNA is allowed to provide under a PAA or Standing Order, despite what may be allowed under Nursing Board rules and regulations.
While AAs are not allowed to select drugs, determine dose, or administration technique for anesthesia or anesthesia-related services without specification by the supervising physician through an order, they perform many of the other same key duties performed by CRNAs. These duties include conducting preoperative physical exams, administering medications, evaluating and responding to life-threatening situations, setting up external and internal monitors, and implementing general and site-specific anesthetic techniques.
Another area of concern relates to handing-off patient care from CRNAs to AAs. RNs have the authority to delegate certain nursing tasks to unlicensed individuals; however, a CRNA and AA do not have any specific delegation authority concerning anesthesia tasks. A physician has the authority to delegate the process of anesthesia-related patient care, including the transfer or hand-off of care from a CRNA to an AA through an order (standing or patient-specific) or protocol. A CRNA or AA cannot set-up or independently delegate a hand-off or step-down process.
While the Nursing Act places responsibility for patient hand-off on a CRNA, if the physician orders a hand-off process from CRNA to AA, and this is memorialized in orders, protocols, etc., then the CRNA does not have the authority to determine the AA is not competent. The reason is that the physician has already made the determination of competency under Chapter 157.001.
Because the CRNA’s authority also arises through the delegating physician, and is not independent of that physician, a CRNA cannot override a physician Order related to this hand-off scenario. If this hand-off became an issue, the CRNA would have a defense (absolute) because the physician has already determined the competency of the AA to accept this patient.