Texas med spa MSO-PC: physician ownership and delegation rules

Direct answer

The full statute list for Texas sits on Texas CPOM, and the CPOM 50-state guide shows how Texas compares with other states. Below is what those rules mean for an aesthetics studio. For other states, start at the med spa MSO-PC hub. General information only, not legal advice. Foundry is not a law firm.

What sits in the PC and what sits in the MSO

Texas forms physician entities under Business Organizations Code chapter 301 as a professional association or a professional limited liability company. A lay founder cannot hold shares in either. Certain licensed professionals may join physicians in limited combinations under that chapter. Confirm your share roster with counsel before you file. Larger health systems sometimes use a nonprofit health organization certified by the board under chapter 162, which is a different build from a single-founder studio.

Why Texas treats an injection as medicine

22 TAC § 169.25 says nonsurgical medical cosmetic procedures are the practice of medicine. The rule names injecting a substance for a cosmetic purpose and using a prescription medical device for a cosmetic purpose, and it lets a physician delegate those procedures to a qualified person. The Texas Medical Board FAQ on nonsurgical medical cosmetic procedures walks through the same points in plain terms. Esthetician and cosmetology services are licensed separately by the Texas Department of Licensing and Regulation, so a facial room and an injector room in the same suite answer to different regulators.

What the delegation rules require before each treatment

Delegation is how a Texas med spa staffs injectors who are not the physician owner. The rules in § 169.26 and § 169.27 set the file a board investigator would ask for:

• The delegate has proper training in the procedure, and the physician signs and dates a written protocol for it.
• Before the first treatment, a physician, PA, or APRN establishes the patient relationship and the patient record is kept.
• The patient is told the name and license of the person who will perform the procedure.
• A person trained in basic life support is present during the procedure.
• A physician, PA, or APRN is on site or immediately available, and the delegating physician can see the patient for an emergency appointment.
• The written order names the delegating physician, the patient selection criteria, the care to be given, and the steps for complications and emergencies.

On the PC path, every one of those documents lives in the PC, signed by the physician owner or the supervising physician the PC engages. The MSO can schedule training and store files, but it cannot write or approve the protocols.

IV therapy after the 2025 law

Occupations Code chapter 172 took effect on September 1, 2025. It covers elective IV hydration and vitamin therapy given outside physician offices, licensed health care facilities, and hospitals. Under it, a physician may delegate prescribing or ordering to a PA or APRN, and administration to a PA, APRN, or RN, under adequate physician supervision. Prescribing delegations follow chapter 157 subchapter B, and each one counts toward the cap on prescriptive authority agreements in § 157.0512(c), without the facility exception in subsection (d). An IV lounge that plans to add locations should count supervision agreements before it hires.

Fees and the money flow

Texas chapter 102 bans paying or receiving remuneration for patient referrals A management fee set as a percentage of injectable revenue is the pattern that draws the most questions. Keep clinical card payments in the PC's account, have the MSO invoice the PC for defined non-clinical services, and price that fee at fair market value. Run the MSA red-flag audit on CPOM compliance before you sign.

Setup steps for a Texas med spa

1. Write the menu and mark every service that uses a prescription drug, a prescription device, or an IV. That list is the PC's work.
2. Match a Texas-licensed physician to own the PC ($3,000/mo) and decide who supervises day to day.
3. Form the professional association or PLLC and the MSO, then sign an FMV management services agreement. See MSO-PC formation ($15,000).
4. Write the delegation file: training records, signed protocols, written orders, and the emergency plan for each procedure.
5. Count prescriptive authority agreements for NPs and PAs, including any IV therapy delegations.
6. Open the PC's bank account and route clinical payments there before the first patient.

Pricing

Texas med spa MSO-PC FAQ

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

Not the medical side. Texas is a Strict corporate practice of medicine state, so the entity that provides injectables, lasers, and IV therapy is usually a professional association or PLLC owned by a Texas-licensed physician. A lay founder can own the MSO that runs the brand, lease, front desk, staff payroll for non-clinical roles, and retail, paid a fair-market-value fee under a management services agreement.

Is Botox the practice of medicine in Texas?

Yes. The Texas Medical Board treats nonsurgical medical cosmetic procedures, including injecting a substance for a cosmetic purpose and using a prescription medical device for a cosmetic purpose, as the practice of medicine under 22 TAC § 169.25. A physician may delegate those procedures to a qualified person under the board's delegation rules.

Does a Texas med spa need a physician on site?

The rules require a physician, PA, or APRN to be on site or immediately available during the procedure, and the delegating physician must be able to see a patient for an emergency appointment if needed (22 TAC § 169.26). A person trained in basic life support must also be present. Confirm the current rule text before you write your staffing plan.

What changed for IV therapy in Texas in 2025?

Occupations Code chapter 172, effective September 1, 2025, sets rules for elective IV therapy given outside physician offices and licensed facilities. A physician may delegate prescribing or ordering to a PA or APRN and administration to a PA, APRN, or RN, under adequate physician supervision. Prescribing delegations follow chapter 157, and each one counts toward the limit on prescriptive authority agreements.

How much does Foundry charge for a Texas med spa MSO-PC?

MSO-PC formation is $15,000 one-time. A Texas-licensed friendly PC owner is $3,000/mo. Typical formation timing is 1 to 3 days after the menu, the locations, and the physician match are scoped. Foundry is not a law firm.

Related reading

Written and last reviewed 2026-10-23 by Matthew Milford, Founder. Sources: 22 TAC §§ 169.25 to 169.27 (Texas Medical Board, nonsurgical medical cosmetic procedures); Texas Medical Board FAQ; Tex. Occ. Code chapters 102, 157, 162, and 172; Tex. Bus. Orgs. Code chapter 301. Foundry PC is not a law firm. General information only, not legal advice.