Texas changed the rules twice in 2025, and most medical director agreements in circulation were written before either change. In January the Medical Board moved the med spa delegation rules out of § 193.17 into a new subchapter. In September an elective IV therapy statute took effect. If your agreement cites § 193.17, it is describing a rule that no longer exists.
The delegation rules moved in January 2025
The Texas Medical Board removed 22 TAC § 193.17 and relocated its content into 22 TAC §§ 169.25 through 169.29, effective 9 January 2025. Same subject, new home, and a structure worth knowing because the obligations are now split across sections:
| section | what it governs |
|---|---|
| § 169.25 | Other Delegation |
| § 169.26 | General Standards |
| § 169.27 | Physician Responsibilities Related to Written Order |
| § 169.28 | Notice and Identification Provisions |
That split matters when you are auditing yourself. A director who has read only the general standards has read a quarter of the obligation.
Section 169.28 puts your director’s name on the wall
This is the one operators discover late. Under § 169.28, any individual, business or facility providing delegated acts must post, in each public area and in each treatment room:
- The notice explaining how to file a complaint with the board, required under § 177.2.
- The name of each delegating physician, including their Texas medical license number.
And under § 169.28(b), every person performing a delegated act must be readily identifiable by a name tag or similar means that clearly shows their identity and credentials.
Walk your rooms. If the director’s name and license number are not on the wall of every treatment room, the arrangement is probably informal in other places too. A director who will not let their name and number be posted is telling you something about how they see the engagement.
The written order is the physician’s responsibility, not the front desk’s
Section 169.27 places responsibility for the written order on the physician. The practical test is whether a specific, competent person made a specific decision about a specific patient before treatment, and whether the record shows it. A standing document that authorizes a menu is not the same thing as an order for a patient, which is why the good faith exam in Texas and the written order are separate records.
Texas also expects the delegating physician, PA or APRN to be present during treatment or immediately available for emergency consultation, and able to see the patient urgently if a complication arises. “Immediately available” is a real standard. A director three time zones away with a full clinic day does not meet it, whatever the agreement says.
Elective IV therapy got its own statute in September 2025
HB 3749, known as Jenifer’s Law, took effect 1 September 2025 and is codified at Tex. Occ. Code ch. 172. It followed a patient death after IV therapy at a Texas med spa.
For an operator the shape is straightforward. A physician may delegate the act of prescribing or ordering elective IV therapy to a PA or an APRN acting under adequate physician supervision. A physician may delegate administering it to a PA, an APRN, or a registered nurse, again under adequate physician supervision.
If IV therapy is on your menu, your protocols need to name who orders and who administers, and those two answers are allowed to be different people. Many menus written before September 2025 do not distinguish them at all.
What drives the cost in Texas
There is no single number, and anyone quoting one without seeing your menu is quoting for a signature. What actually moves it:
- Menu breadth. Injectables alone is a narrower protocol burden than injectables plus IV therapy plus weight management plus hormones.
- IV therapy specifically. Chapter 172 added a second framework on top of the delegation rules, with its own ordering and administration split.
- Site count and staffing. Each location that needs a physician immediately available is a separate availability problem.
- Who writes the protocols. Authorship, review, and revision when the menu changes is the work. A fee that assumes none of it is buying none of it.
- Whether the director is actually reachable. Availability has a cost, and a director who is genuinely reachable during clinic hours prices differently from one who is not.
Fee structures in this market vary and are best read as market observation rather than a benchmark. What matters is what the fee buys.
Red flags on both sides
From the operator’s side: a director who cites § 193.17, which has not existed since January 2025; who declines to have their name and license number posted; who will not commit to being reachable during clinic hours; or who offers to sign before seeing the service menu.
From the physician’s side: an operator who wants the agreement signed before the menu is settled; who treats the written order as paperwork rather than a clinical decision; who has IV therapy live without separating ordering from administration; or who proposes compensation that moves with clinic revenue. Revenue-linked pay is the highest-risk formulation available and nothing about a Texas directorship requires it.
What this means for you
Open your current agreement and search it for “193.17”. If it is there, the agreement is describing a superseded rule and needs rewriting against §§ 169.25 to 169.29. Then walk each treatment room and each public area and check for two postings: the board complaint notice under § 177.2, and the delegating physician’s name with their Texas medical license number. Check that everyone performing a delegated act is wearing identification showing their credentials. If IV therapy is on the menu, separate the ordering decision from the administration step in writing, because Chapter 172 treats them as different delegations. See what medical direction in Texas involves, or read the delegation rules in detail.
Related reading
Frequently asked questions
Does a Texas med spa need a medical director?
If your menu includes delegated medical acts, and injectables and elective IV therapy both are, then yes: those acts are delegated by a physician and the delegation has to come from somewhere. Texas does not license med spas as facilities, so the physician relationship is the structure carrying the compliance, not a facility permit.
What replaced 22 TAC § 193.17?
The Texas Medical Board removed § 193.17 and relocated its content into 22 TAC §§ 169.25 through 169.29, effective 9 January 2025. General standards sit at § 169.26, written-order responsibilities at § 169.27, and notice and identification at § 169.28. An agreement still citing § 193.17 is out of date.
What has to be posted in a Texas treatment room?
Under § 169.28, each public area and each treatment room must display the board complaint notice required by § 177.2 and the name of each delegating physician including their Texas medical license number. Separately, each person performing a delegated act must wear identification clearly showing their identity and credentials.
What changed for IV therapy in Texas in 2025?
HB 3749, Jenifer’s Law, took effect 1 September 2025 as Tex. Occ. Code ch. 172. A physician may delegate prescribing or ordering elective IV therapy to a PA or APRN under adequate supervision, and administering it to a PA, APRN or RN under adequate supervision. Ordering and administering are treated as separate delegations.
Can a Texas medical director be paid a percentage of revenue?
It is the highest-risk compensation structure available and no part of a Texas directorship requires it. A fixed fee reflecting fair market value for defined services is the more defensible arrangement, and it is also easier to explain to a buyer during diligence.
This is general information, not legal advice. Rules vary by state and change. Confirm your own facts with counsel.