Med Spa Regulations by State
Compare medical-spa compliance requirements across all US states — who can inject, good-faith exam, medical director, ownership, laser and IV rules — each with primary-source citations.
48 of 51 states
allow RNs to inject
See all 51 →
51 of 51 states
require a good-faith exam
See all 51 →
27 of 51 states
require a medical director
See all 51 →
20 of 51 states
restrict med-spa ownership to physicians (CPOM)
See all 51 →
43 of 51 states
let RNs operate lasers
See all 51 →
Browse by topic
Who can inject
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Good-faith exam
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Medical director
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Ownership / CPOM
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Laser / energy devices
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Compare all states
At-a-glance answers — scroll sideways for all 10 topics, or open a state for the full wording and sources.
| State | Who can inject | Good-faith exam | Medical director | Ownership / CPOM | Supervision | Esthetician scope | Laser / energy devices | IV therapy | Med-spa registration | Penalties / enforcement |
|---|---|---|---|---|---|---|---|---|---|---|
| Alabama full detail & sources → | MD, DO, NP, PA | Required · telehealth OK | Required | Non-physician OK | Physician must be physically on-site for cosmetic Botox injections; for lasers, on-site… | Non-invasive epidermal/stratum-corneum skin care only; no cutting/altering living cells; no… | MD, DO, PA, NP, RN, LPN, medical assistant, esthetician, cosmetologist, laser technician | Physician/PA/CRNP/CNM must personally evaluate, diagnose, and prescribe (in person or via… | No med-spa facility license; but per-physician laser/LLBD device registration with ALBME… | Unlicensed practice of medicine = Class C felony (§ 34-24-51); physician aiding/abetting… |
| Alaska full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | PAs need a documented physician collaborative plan (AS 08.64.170; 12 AAC 40.410); APRNs… | Cosmetic skin care only (skin care, make-up, temporary hair removal on scalp/face/neck)… | MD, DO, NP, PA, RN | IV initiation/administration/monitoring cannot be delegated to unlicensed staff (12 AAC… | No med-spa-specific state registration or facility license; operate under practitioner… | Unlicensed practice of medicine = class A misdemeanor, each day a separate offense (AS… |
| Arizona full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Non-physician OK | Tiered: Level I no order/supervision; Level II LP order + indirect supervision; Level III LP… | Beautification services only, in a licensed establishment; Level I procedures allowed… | MD, DO, NP, PA, RN, LPN, certified laser technician, cosmetologist, aesthetician | RN/LPN/APRN may administer IV; RN/LPN need an individualized LP order preceded by a patient… | No med-spa-specific registration/license. Mandatory: register laser/IPL/RF devices with ADHS… | Unlicensed practice of medicine = class 5 felony (A.R.S. § 32-1455); misrepresenting as a… |
| Arkansas full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Physician-owned only | RN acts under patient-specific/standing order of a physician or APRN who is available in person… | Aestheticians are limited to superficial, non-medical skin care (cleansing, waxing, facials… | MD, DO, NP, PA, RN | No AR-specific med-spa IV rule; IV drugs/fluids must be ordered by a physician or… | No med-spa-specific registration or license; a medicine-practicing PLLC must obtain an ASMB… | Unlicensed practice of medicine (incl. unauthorized injections/laser) = misdemeanor, $250-$500… |
| California full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Physician-owned only | RNs: physician delegation + standardized procedure/patient-specific order, physician… | No authority to practice medicine; limited to epidermis; no injections, no medical lasers/IPL… | MD, DO, RN, PA, NP | Not med-spa-specific; requires prescriber order + good faith exam; RN administers under… | No dedicated med-spa license or registration; regulated as a physician medical practice; must… | BPC 2052 unlicensed practice: up to $10,000 fine and/or up to 1 year county jail or state… |
| Colorado full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | Physician need not be on-site if detailed written procedure + emergency protocols exist, but… | Superficial (epidermis-only) services; cannot penetrate below the epidermis, use Class IIIb+… | MD, DO, NP, PA, RN | IV/injection therapy is the practice of medicine; requires a physician/PA/APRN order and RN or… | No med-spa-specific facility license/registration exists; regulation flows through practitioner… | Unlicensed practice of medicine: cease-and-desist orders, injunctions, and criminal liability… |
| Connecticut full detail & sources → | MD, DO, NP, PA, RN | Required · in person | Required | Non-physician OK | RN acts under direction of a physician/dentist/APRN (or PA orders) per § 20-87a(a); PA… | Skin care, exfoliation, makeup, lash/brow work, and manual/mechanical hair removal are within… | MD, DO, PA, APRN, RN | No CT IV-specific rule; general nursing/medical acts apply. Prescriber (MD/DO/PA/APRN) must… | No state med-spa license or registration and no DPH med-spa regulations; only § 19a-903c(d)… | Unlicensed/out-of-scope practice of medicine = class D felony, each patient contact a separate… |
| Delaware full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | Physician delegating to non-physicians must supervise: direct (on-premises) supervision when a… | Estheticians may perform non-medical skin care, hair removal, lash extensions and… | MD, DO, NP, PA | IV therapy requires a physician/APRN/PA order (APRNs independent); RNs administer under a valid… | No med-spa facility registration or licensing exists in Delaware; only facilities performing… | Board may levy fines and restrict, suspend, or revoke a license for unprofessional conduct (§… |
| District of Columbia full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | No general physician-supervision mandate for NPs (full practice authority); PAs work in… | Estheticians/cosmetologists limited to Level I non-medical services; basic esthetics excludes… | MD, DO, NP, PA, RN | No IV-specific rule; governed by general practice-of-medicine/nursing law — requires a… | No standalone med-spa license or registration; med spas operate as physician-owned medical… | Unlicensed practice prohibited (§ 3-1210.01); criminal penalty up to 1 yr imprisonment and up… |
| Florida full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | RNs administer only under a prescriber's order (464.003); PAs under physician supervision incl… | Facial specialists may perform facials, superficial face/scalp treatments, body skin care… | MD, DO, electrologist (under direct physician supervision) | No IV-specific statute; IV therapy = practice of medicine/nursing — physician/APRN/PA orders… | No dedicated med-spa license; operate as a practitioner-owned practice (HCCA-exempt) or a… | Unlicensed practice of medicine = 3rd-degree felony (458.327); licensee discipline up to… |
| Georgia full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Non-physician OK | APRN: physician available for immediate consultation + annual on-site observation + quarterly… | Estheticians limited to superficial skin-care/grooming (facials, waxing, massage, brow/lash… | MD, DO, PA, NP, senior/assistant cosmetic laser practitioner | Order/prescribe: physician, APRN (with prescriptive nurse protocol), or PA (with job… | No med-spa-specific license or registration. Med spas operate under the general Medical… | Criminal: unlicensed practice of medicine is a felony (O.C.G.A. 43-34-42) — $1,000/violation… |
| Hawaii full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | PAs practice under physician direction/control per Board rule; physician need not be on-site… | Non-medical skin care only: massaging, cleansing, stimulating, exfoliating, beautifying, and… | MD, DO, NP, PA, RN | No IV-specific statute. RN administers under a valid order from an authorized prescriber… | No med-spa-specific facility license or registration exists. Individual practitioners must be… | Unlicensed practice of medicine: fine up to $500 and/or up to 6 months imprisonment, each day a… |
| Idaho full detail & sources → | MD, DO, NP, PA, RN | Required · in person | Required | Non-physician OK | Physician must be on-site or immediately available; documents pre-treatment evaluation; max 3… | Noninvasive skin care only; FDA Class I devices independently; Class II devices only under… | MD, DO, NP, PA, RN | No IV-specific statute; parenteral therapy is practice of medicine — ordered by… | No standalone med-spa license/registration; governed by the Medical Practice Act (practitioner… | Unlicensed practice of medicine = felony (up to 5 years and/or $10,000 fine); civil recovery of… |
| Illinois full detail & sources → | MD, DO, NP, PA, RN | Required · in person | Required | Non-physician OK | Physician delegation within a physician-patient relationship; on-site licensed professional… | Estheticians/cosmetologists may not affect the living layers of skin or treat medical… | MD, DO, NP, RN | No IV-specific statute; IV/vitamin and weight-loss injections are drug administration and the… | No dedicated med-spa license; the medspa must be a registered medical corporation, PSC, or PLLC… | Unlicensed practice of medicine/nursing (e.g., unauthorized Botox injections) draws IDFPR civil… |
| Indiana full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Non-physician OK | NP/APRN: collaborative practice agreement with a physician required (IC 25-23-1-19.4) plus… | Non-medical skin care only (facials, exfoliation, extraction, waxing, makeup) per 820 IAC… | MD, DO, NP, PA, RN | IV/parenteral nutrient therapy is a defined SB 282 med-spa service; requires a prescriber's… | Mandatory registration with the Medical Licensing Board from Jan 1, 2027 (procedure set by Oct… | Up to $5,000 fine for an unregistered med spa (IC 25-22.5-12.5-3(c)); licensee discipline under… |
| Iowa full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Non-physician OK | Medical director: direct in-person on-site supervision >=4 hrs/week (documented); weekly… | Superficial/non-medical skin care only; laser-IPL hair removal & microdermabrasion allowed with… | MD, DO, NP, PA, RN | No IV-specific med-spa statute; IV therapy needs a prescriber's order (MD/DO/NP/PA) and is… | No separate med-spa facility license/registration; regulated via the physician medical director… | Board of Medicine discipline under Iowa Code 148.6: civil penalty up to $10,000 plus… |
| Kansas full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Physician-owned only | APRN independent (no supervision since 7/2022); PA needs supervising physician (no physical… | Noninvasive only — cleansing/stimulating skin surfaces, temporary hair removal (no electric… | MD, DO, NP, PA, RN | Medical act — prescriber must evaluate/diagnose and order before IV meds are administered… | No med-spa-specific license; medical services must run through a licensee-owned professional… | Unlicensed healing-arts practice = severity level 10 nonperson felony + up to $1,000/day civil… |
| Kentucky full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | RN: supervision (provider on premises or readily available by phone) + medical plan of care… | Kentucky estheticians (Board of Cosmetology licensees under KRS 317A) are limited to… | MD, DO, NP, PA, RN | Practice of medicine: MD/DO/PA/APRN must establish relationship, do good-faith exam, diagnose… | No med-spa registration or dedicated facility license. Regulated indirectly via practitioner… | Board discipline for scope/licensure violations — monetary fines, probation, suspension, or… |
| Louisiana full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Non-physician OK | On-site (physically present) physician direction and immediate personal supervision required… | Epidermis-only, non-medical scope; no injections, no lasers, no FDA-classified medical devices… | MD, DO, NP, PA, RN | IV therapy = practice of medicine; diagnosis/prescription limited to MD/DO, PA, NP (CRNP), or… | No med-spa-specific registration/license. Governed by general Medical Practice Act via a… | Criminal: R.S. 37:1290 — $250–$500 fine and/or 10 days–5 months imprisonment per offense… |
| Maine full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | RN: under prescriber order + physician delegation, no on-site presence required. PA… | Non-medical skin care only; low-strength exfoliation/microdermabrasion allowed; no dermal… | MD, DO, NP, PA, RN | Prescriber order required after a good-faith exam; RN administers under that order. No… | No med-spa-specific registration; medical acts covered by practitioner licenses; aesthetics… | Unlicensed practice of medicine = Class E crime (32 MRS 3270); board discipline… |
| Maryland full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | On-site physician supervision required whenever a non-physician performs cosmetic procedures… | Estheticians limited to superficial, non-medical care (facials, exfoliation, massage/toning… | MD, DO, NP, PA, RN | IV/infusion therapy is a regulated nursing act (COMAR 10.27.20) requiring a prescriber's order… | No med-spa-specific facility license or registration; regulated through Board of Physicians… | Physician discipline for improper delegation/supervision of a cosmetic medical procedure (COMAR… |
| Massachusetts full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | PA: supervising physician required (no on-site presence required; up to 2 PAs per physician)… | Superficial, non-medical skin care only (cleansing, exfoliation, superficial peels, masks… | MD, DO, NP, PA, RN | Medical service. Requires a prescriber order (MD/DO/NP/PA) after patient evaluation… | No med-spa-specific registration or facility license. Operates as a medical practice (business… | Unauthorized practice of medicine (M.G.L. c. 112 §6): fine $100–$1,000 and/or imprisonment 1… |
| Michigan full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | Physician supervision per MCL 333.16109 (direct-communication availability, regular review… | Esthetician license (Occupational Code Art. 12, MCL 339.1203a) is limited to non-medical 'skin… | MD, DO, NP, PA, RN | No IV-specific statute; IV therapy requires a prescriber's order (physician/NP/PA within scope)… | No med-spa-specific registration/license in Michigan; the facility must be a physician-owned PC… | Unlicensed practice / practice outside delegation = felony (MCL 333.16294); other Article 15… |
| Minnesota full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | PA: written practice agreement, annual physician review (147A.09). APRN: independent after… | Cosmetic care of the skin/epidermis only; no injectables, no medical lasers, no dermal or… | MD, DO, NP, PA, RN | No IV-specific statute; IV drugs/fluids require a prescriber order (MD/DO/NP/PA) and RN… | No med-spa-specific license or registration in Minnesota; governed by individual practitioner… | Unlicensed practice of medicine = gross misdemeanor (147.081 subd. 2). Licensee discipline for… |
| Mississippi full detail & sources → | MD, DO, NP, PA | Required · telehealth OK | Required | Non-physician OK | Auxiliaries act under physician supervision (direct/oversee/inspect); NPs need a filed… | Estheticians (MS Board of Cosmetology) are confined to superficial cosmetic skin care; no… | MD, DO, NP, PA, RN | No IV-specific statute; prescriber (MD/DO/NP/PA) must order after a good-faith exam, RN… | No med-spa registration/license; boards do not license or inspect med spas. Only Level II/III… | Unlicensed practice = misdemeanor (fines $100-$5,000, jail/prison up to 5 yrs) + injunction… |
| Missouri full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | Written collaborative practice arrangement required; collaborating physician within 30 road… | Class E esthetician limited to superficial cosmetic care with cosmetic preparations up to 10%… | MD, DO, NP, PA, RN | No IV-therapy-specific statute; prescription IV drugs require an authorized prescriber's order… | No med-spa facility license or registration exists in Missouri. DHSS facility licensure (RSMo… | Unlicensed cosmetology practice = class C misdemeanor (RSMo 329.250) plus board… |
| Montana full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | PA (<8,000 hrs) requires a collaborative agreement with a physician/experienced PA (37-20-203)… | Noninvasive skin care confined to the stratum corneum (facials, exfoliation, waxing, light… | MD, DO, NP, PA, RN | No med-spa-specific IV statute; IV therapy is nursing/medical practice ordered by a… | No med-spa license/registration; facilities not regulated by professional boards. DPHHS may… | MCA 37-1-109: cease-and-desist for unlicensed practice; civil penalty up to $1,000/day for… |
| Nebraska full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | MD/DO independent; NP requires collaborative/transition-to-practice agreement for first 2,000… | Esthetics is superficial, non-medical skin care 'upon the skin for personal beauty care'; no… | MD, DO, NP, PA | No IV-specific statute; a prescriber (MD/DO, NP, or supervised PA) must order the therapy and… | No med-spa-specific registration/license; medical services governed by provider licensure and… | Unauthorized practice of medicine → cease-and-desist order; continuing after the order is a… |
| Nevada full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Physician-owned only | NRS 644A.545 requires an advanced esthetician to perform any nonablative esthetic medical… | Estheticians do non-invasive skin care only (no esthetic medical devices, no… | MD, DO, NP (APRN), PA, RN, LPN, advanced esthetician (nonablative only, under supervision of a physician/PA/APRN per NRS 644A.545 — no ablative work) | No med-spa-specific IV statute; IV infusions are dangerous-drug administration requiring a… | No med-spa-specific registration; an esthetics facility needs a cosmetological establishment… | Unlicensed practice of medicine = category D felony (category C if substantial bodily harm)… |
| New Hampshire full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | APRN independent (no supervision); PA needs a written physician collaboration agreement unless… | Esthetics is limited to facials, makeup, non-medical skin care, superfluous hair removal, and… | MD, DO, NP, PA, RN | No IV-specific statute; IV/infusion therapy requires an order from a physician, APRN, or PA and… | No med-spa registration/licensing statute exists (HB 105 of 2024 died); med spas fall under the… | Unlicensed practice of medicine: misdemeanor (first offense), felony for entities on subsequent… |
| New Jersey full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | PAs act only under supervising-physician direction/delegation (N.J.S.A. 45:9-27.16); APNs… | Estheticians ('skin care specialists') under Board of Cosmetology (N.J.A.C. 13:28) do… | MD, DO, PA | IV therapy is a medical act needing a prescriber's order (MD/DO, or APN/PA under… | No med-spa registration/licensing regime in NJ; med spas operate as physician-owned medical… | Civil penalties up to $10,000 (first) / $20,000 (each subsequent) for unlicensed or… |
| New Mexico full detail & sources → | MD, DO, NP, PA, RN | Required · in person | Not required | Non-physician OK | RN aesthetic practice requires APRN delegation + indirect supervision; LPN requires direct… | Non-invasive skin care only (cleansing, massage, light/high-frequency facials, makeup… | MD, DO, NP, PA, RN, LPN | IV therapy is a listed aesthetic procedure; must be ordered via non-delegable face-to-face… | No med-spa-specific facility license/registration; the state regulates practice within… | Unlicensed practice of medicine = fourth-degree felony, up to 18 months' imprisonment and up to… |
| New York full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Physician-owned only | PA: physician-delegated, continuous (not on-site) supervision, ≤6 PAs per private-practice… | DOS appearance-enhancement license (GBS Art. 27). Permitted: facials, exfoliation, superficial… | MD, DO, NP, PA, RN | IV therapy = practice of medicine (DOS med-spa chart: Medical license). Ordered by MD/DO/NP/PA… | No standalone med-spa license. Medical services delivered via a physician-owned PC/PLLC… | Unlicensed practice / aiding unlicensed practice = Class E felony (Education Law §6512)… |
| North Carolina full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | RN needs no on-site prescriber; LPN needs on-site supervision; laser requires physician on-site… | Estheticians (G.S. 88B) limited to superficial skin care, light/superficial peels, and… | MD, DO, NP, PA, RN | No med-spa-specific rule; RN/LPN may administer IV hydration/vitamin/medication therapies only… | No med-spa-specific facility license/registration; med spas operate under the general Medical… | Unlicensed practice of medicine = Class 1 misdemeanor (Class I felony if falsely claiming… |
| North Dakota full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | Prescriber order + ongoing prescriber involvement for nurse-delivered services (NDAC… | Esthetics limited to noninvasive care; no cutting/puncturing/laser-light-energy damage to… | MD, DO, PA, NP, RN, advanced esthetician | RN or IV-certified LPN may administer only under a prescriber (MD/PA/APRN) order following a… | No med-spa/medical-clinic facility license or registration exists; Board of Nursing has no… | Unlicensed practice of medicine (or unspecified ch. 43-17 violations) = class B misdemeanor +… |
| Ohio full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Non-physician OK | Physician determines supervision level for delegated tasks; on-site supervision required for… | Non-invasive, stratum-corneum-only scope; no injections, microneedling, or devices that… | MD, DO, PA, RN, LPN | IV therapy requires a prescriber's order; administered by RN (broad) or LPN (restricted, no IV… | No dedicated Ohio med-spa license or facility registration; governed by general business law… | Unlicensed practice of medicine is a crime/enjoinable (ORC 4731.41); Medical Board disciplinary… |
| Oklahoma full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Non-physician OK | PA: general supervision, physician need not be present if reachable by telecom. RN: general… | Licensed by Board of Cosmetology & Barbering (OAC 175:10-7-29). May do skin care, makeup, hair… | MD, DO, NP, PA, RN | Governed by OK Board of Nursing IV Hydration Guidelines (59 O.S. 567.3a). Requires… | No med-spa-specific license or facility registration. Operates as a medical practice under the… | No med-spa-specific penalty. Physician discipline under 59 O.S. 509.1: revocation, suspension… |
| Oregon full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Physician-owned only | NP/APRN independent (Oregon Nurse Practice Act limits diagnose/treat authority to APRNs); PA… | Estheticians may not inject (practice of medicine). Basic esthetics = skin/facial care (ORS… | MD, DO, NP, PA, RN | Order/prescribe: MD, DO, PA, APRN with prescriptive privilege, ND with prescribing endorsement… | No med-spa-specific registration/licensure. Governed by: professional-corporation organization… | Unlicensed practice of medicine = Class C felony (ORS 677.990(2), for conduct prohibited by ORS… |
| Pennsylvania full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | Physician delegation with responsibility but no mandatory on-site presence; PAs under a… | Superficial skin-care/beauty only (facials, cosmetic products, waxing/tweezing hair removal… | MD, DO, NP, PA, RN | IV therapy requires a prescriber's order (MD/DO/PA/CRNP); an RN trained in IV/venipuncture… | No dedicated med-spa license; operate as a physician-owned professional entity (CPOM) with… | Unauthorized practice = 3rd-degree misdemeanor: 1st offense up to $2,000 fine and/or up to 6… |
| Rhode Island full detail & sources → | MD, DO, PA, NP | Required · telehealth OK | Required | Non-physician OK | Physician/PA/APRN supervision required for delegated procedures; supervision is either direct… | Esthetics = cleansing/stimulating/manipulating/beautifying skin (RIGL § 5-10-1(8)); RIDOH… | MD, DO, PA, NP, Electrologist | IV therapy is practice of medicine; only MD/DO, PA, or family-practice/adult-gerontology CNP… | Med spas are licensed healthcare facilities: RIGL § 23-105-1(8) defines a medical spa as a… | No med-spa-specific penalty in ch. 23-105; unlicensed facility operation = up to $5,000 fine… |
| South Carolina full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | PA: supervising physician readily/immediately available. NP/CNM/CNS: written practice agreement… | Esthetician scope limited to non-medical skin care/make-up 'for the sole purpose of beautifying… | MD, DO, NP, PA, RN | IV therapy = practice of medicine. Order/prescribe: MD/DO, PA (supervising physician), or… | No med-spa-specific license/registration. General business licensing + clinician practice laws… | Unlicensed practice of medicine (incl. RN acting outside scope, and physicians/PAs/APRNs… |
| South Dakota full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Non-physician OK | RN: indirect (off-site) supervision permitted for delegated aesthetic procedures; LPN: direct… | Non-invasive, superficial skin care only (stratum corneum); microdermabrasion (16 hrs training)… | MD, DO, NP, PA | RN and LPN may administer elective IV/vitamin therapy only under an authorized provider's order… | No med-spa-specific registration; entities register by profession — Medical Practice Act… | Unlicensed practice of medicine = Class 1 misdemeanor (SDCL 36-4-8); false personation of a… |
| Tennessee full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | PA: supervising physician + written protocols + >=20% chart review every 30 days; APRN… | Epidermis-only skin care; no dermis-affecting procedures, no injections, no medical lasers; AHA… | MD, DO, NP, PA, RN | No IV-specific rule; order required from MD/DO/NP/PA after good-faith exam, RN administers… | Mandatory registration with TN Board of Medical Examiners before operation; $175 non-refundable… | Unregistered operation = unprofessional conduct / physician discipline; general discipline and… |
| Texas full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | Physician onsite or immediately available for emergencies and able to see the patient; written… | Epidermis-only: superficial/light peels and above-dermis microdermabrasion permitted… | MD, DO, NP, PA, RN | Practice of medicine (injection of substances); requires physician order/delegation plus a… | No med-spa-specific license; multi-agency regulation (TMB, TDLR, BON, DSHS) based on services… | Unlicensed practice of medicine = third-degree felony (each day a separate offense); physicians… |
| Utah full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | APRN independent; PA under collaborative practice agreement with supervising physician; RN… | Basic esthetician: facials, waxing, makeup, limited peels, microdermabrasion. Master… | MD, DO, NP, PA, RN | IV therapy = practice of medicine/nursing; prescriber (MD/DO/APRN/PA) orders after evaluation… | No med-spa facility license/registration in Utah; DOPL licenses individuals, not med-spa… | DOPL license discipline + fines; cosmetology citation fines ~$500–$2,000/offense (double for… |
| Vermont full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Physician-owned only | PA under written practice agreement with participating physician accessible for consultation at… | Skin-care/beautifying only using cosmetic preparations and mechanical/electrical devices… | MD, DO, NP, PA, RN, electrologist (hair-removal endorsement only) | No IV-specific statute; IV administration of fluids/medications is practice of medicine (26… | No med-spa-specific registration/license; Board of Medical Practice licenses only individual… | Unlicensed practice of medicine: up to 2 years imprisonment and/or up to $10,000 fine, no fee… |
| Virginia full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | NPs: practice agreement with a patient care team physician; autonomous only after ~3… | Estheticians/master estheticians limited to superficial, non-invasive skin care with cosmetic… | MD, DO, NP, PA, delegated trained operator under supervision | IV therapy requires a practitioner's order; RNs/technicians may administer IV infusions and… | No medical-spa facility registration/licensure in Virginia; medical services regulated via… | Unlicensed practice of medicine is prohibited (§ 54.1-2902); willful unlicensed practice is a… |
| Washington full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Non-physician OK | Injectables (approved drug/approved use): physician off-site OK but reachable and able to… | Estheticians/master estheticians may do non-invasive cosmetic skin services independently but… | MD, DO, NP, PA, RN | RN may perform IV/infusion therapy (peripheral and CVAD access, administration of… | No med-spa facility registration/licensing regime. Compliance runs through individual… | Unlicensed practice (RCW 18.130.190): cease-and-desist + civil fine up to $1,000/day; first… |
| West Virginia full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Required | Physician-owned only | APRN prescribes under a written physician collaborative agreement (or independently after 3… | Cosmetic, non-medical skin care only (cleansing, exfoliation, waxing, applying cosmetics, body… | MD, DO, NP, PA, RN | No IV-specific statute; a prescriber (MD/DO/NP/PA) must order the therapy per §30-3-4, and an… | No med-spa-specific registration or facility license; a corporation practicing medicine must… | Unlicensed practice of medicine: misdemeanor up to $5,000 fine and/or 12 months jail (license… |
| Wisconsin full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Physician-owned only | Physician direction + written protocols for delegated cosmetology medical procedures (Cos… | Aesthetics = skin cleansing/beautifying only; no diagnosis/prescribing/disease treatment except… | MD, DO, NP, PA, RN, cosmetologist/aesthetician (delegated, physician-directed) | No IV-specific statute; IV drug/fluid administration requires a prescriber's order… | No med-spa facility registration exists. Cosmetology/aesthetic services require a cosmetology… | Unlicensed medical practice/other ch. 448 violations: up to $10,000 fine and/or 9 months jail… |
| Wyoming full detail & sources → | MD, DO, NP, PA, RN | Required · telehealth OK | Not required | Non-physician OK | APRN independent (no supervision/collaboration required); PA collaborates at practice level… | Superficial skin care only; laser and electrolysis excluded; skin-piercing/invasive procedures… | MD, DO, NP, PA, RN | No IV-specific statute; must be ordered by a physician/independent APRN/PA (practice of… | No med-spa facility license/registration; med spas operate under general medical (ch. 26) and… | Unlicensed practice of medicine (or aiding it) = misdemeanor up to $1,000 and/or 1 yr jail per… |
Methodology & sources
Each state's requirements are compiled from primary sources — state statutes, medical- and nursing-board rules, and official guidance — and reviewed by our compliance team. Every field links to its source. Last dataset review dates are shown on each state page. Download the full dataset as CSV.
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This information is provided for general educational purposes only and is not legal advice. Regulations change — verify current requirements with your state medical/nursing board before acting.