Maryland Med Spa Compliance

How Maryland Regulates Med Spas: Seven Points

Each point condenses one part of our Maryland record; the citations sit on the regulations page.

• One chapter governs cosmetic work. Maryland has no med spa statute or facility license. Cosmetic medical procedures fall under the Board of Physicians' chapter, COMAR 10.32.09.
• Injections and devices are treated alike. COMAR 10.32.09.02 defines injection as a cosmetic medical procedure and treats lasers, IPL, and radiofrequency equipment as cosmetic medical devices, so the same staffing rules apply to both.
• Physician first, every patient. The physician must personally perform the initial assessment and write a treatment plan with a diagnosis and planned course of treatment (COMAR 10.32.09.05).
• Delegate to a PA; assign to a CRNP or RN. Under COMAR 10.32.09.04, a physician delegates to a physician assistant or assigns to another licensed provider whose own board treats the procedure as within scope. Our record does not list LPNs.
• The physician stays on site. On-site supervision is required whenever a non-physician performs a cosmetic medical procedure. A PA under a Board-approved delegation agreement may be supervised on an "immediately available" basis after the physician's assessment and plan.
• Physicians own the medical practice. The corporate practice of medicine doctrine applies in Maryland, resting on Health Occupations §14-301 and Corporations and Associations §5-105.
• Estheticians stop at the epidermis. Board of Cosmetologists licensees perform superficial skin care, with microneedling limited to 1 mm and not beyond the epidermis (COMAR 09.22.01.04).

Five Maryland Mistakes We See Most

Most Maryland problems come from importing a staffing model that works in a neighboring state.

• Nurse injector hours with no physician in the building. Outside the PA delegation-agreement exception, our record requires the physician on site whenever a non-physician injects.
• Letting a nurse practitioner or RN do the new-patient assessment. COMAR 10.32.09.05 says the physician performs the initial assessment personally.
• Relying on an injector course instead of observed training. COMAR 10.32.09.07 requires training to competency under the delegating physician's direct, present observation.
• Reading full practice authority as a cosmetic shortcut. Our record frames CRNP cosmetic injecting as an assignment within the physician framework.
• Letting a "laser tech" run devices. Lasers, IPL, and radiofrequency are cosmetic medical devices, and unlicensed technicians and estheticians may not operate them.

Each of those mistakes is unpacked license by license in who can inject Botox in Maryland, and the underlying citations are collected in our Maryland regulations reference.

The Maryland Agencies Behind a Med Spa

Maryland issues no med spa permit, so a clinic answers to whichever body licensed each person on its staff. The Board of Physicians licenses physicians, wrote the cosmetic procedure chapter at COMAR 10.32.09, and disciplines physicians who delegate, assign, or supervise improperly. The Board of Nursing licenses RNs, LPNs, and CRNPs, and defines infusion therapy at COMAR 10.27.20.02. The Board of Cosmetologists, part of the Maryland Department of Labor, licenses estheticians under COMAR 09.22.

The penalties reach well beyond a license. Our record puts the fine for a non-physician who performs a cosmetic medical procedure without authorization at up to $50,000 under COMAR 10.32.09.09. Unlicensed practice is also a felony under Health Occupations §14-606, with a fine of up to $10,000 and up to five years' imprisonment, plus a separate civil fine of up to $50,000. A disciplinary panel may also seek a cease-and-desist order or an injunction under §14-206(e).