Question 1

Who can inject Botox and dermal fillers in Colorado?

Accepted Answer

Colorado treats the injection of any substance into the human body (neuromodulators, dermal fillers) as the practice of medicine. Physicians (MD/DO) may perform injections and may delegate them to a physician assistant, registered nurse, or even a trained unlicensed person under a written delegation agreement and physician supervision (Rule 800); advanced practice registered nurses (nurse practitioners) who hold prescriptive authority may prescribe and inject independently. The prescription drug itself (e.g., botulinum toxin) must be ordered by a physician, PA, or APRN with prescriptive authority.

Question 2

Does Colorado require a good-faith exam before treatment?

Accepted Answer

Colorado does not codify the specific term 'good faith exam' for aesthetics, but Rule 800 requires delegated medical-aesthetic services to be provided in the context of an appropriate physician/patient relationship, with the physician performing an initial consultation and reviewing care; a prescriber must likewise establish a valid provider-patient relationship before prescribing the drug. Telehealth technologies may be used to establish the relationship and provide the physician's consultation or follow-up, but the delegating physician should not rely exclusively on telehealth for supervision.

Question 3

Does a med spa in Colorado need a medical director?

Accepted Answer

Colorado has no dedicated 'medical spa medical director' statute, but any med spa that delivers injections or medical (Class IIIb+) lasers through non-physicians who are not independently licensed for the act (RNs and unlicensed staff) must operate under a delegating/supervising physician who satisfies Rule 800, and the rule expressly contemplates a physician entering an agreement to serve as a medical director. A nurse practitioner with full prescriptive/practice authority may own and operate a med spa and inject without a supervising physician.

Question 4

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

Accepted Answer

Colorado follows the corporate practice of medicine doctrine. Under C.R.S. 12-240-138, a professional entity organized to practice medicine must be owned by Colorado-licensed physicians (physician assistants may be minority shareholders only if physicians retain majority ownership), and lay directors, officers, and heirs may not exercise any authority over a physician's independent medical judgment; the statute states plainly that 'corporations shall not practice medicine.' Med spas therefore commonly pair a physician-owned professional medical entity with a management services organization (MSO) that handles non-clinical business functions.

Question 5

What supervision does Colorado require for med-spa procedures?

Accepted Answer

Under Rule 800, a delegating physician need not be physically on the premises if specific and detailed written procedure protocols and written emergency protocols are in place, but must be physically present in Colorado (or name a covering physician who is) and available to promptly, personally attend to the patient. The physician must monitor the quality of the delegatee's work at the site at least every two weeks, personally reassess the delegatee's competence at least annually (including over-the-shoulder observation), and review each patient's chart within fourteen days. Registered nurses and APRNs act under the Nurse Practice Act (delegation/self-direction) rather than under Rule 800.

Question 6

What can an esthetician legally do in Colorado?

Accepted Answer

Estheticians are licensed by the Office of Barber and Cosmetology Licensure and their scope is limited to superficial skin services. They are expressly prohibited from performing any service that penetrates, destroys, or alters the client's skin beyond the epidermis, from using Class IIIb-or-higher medical devices for anything other than the device's intended use, and from anything that would require delegation under the Medical Practice Act unless such delegation is actually in place. After completing additional training, an esthetician's scope may add cosmetic resurfacing exfoliation, microdermabrasion, and pigment implantation, but never injections or medical (Class IIIb+) laser procedures.

Question 7

Who can operate a cosmetic laser in Colorado?

Accepted Answer

Use of a Class IIIb-or-higher laser, intense pulsed light, or radio-frequency device that revises, destroys, incises, or otherwise structurally alters human tissue (or is used for hair removal) is a medical service constituting the practice of medicine. It may be performed by a physician or delegated under Rule 800 to a physician assistant, registered nurse, nurse practitioner, or a trained unlicensed delegatee under physician supervision. Class I, II, and IIIa devices (including Class IIIa lasers) do not constitute a medical service and fall outside these rules.

Question 8

What are the rules for IV therapy and vitamin drips in Colorado?

Accepted Answer

IV therapy (IV vitamin/hydration infusions and other injections) is the 'injection of any substance into the human body' and is therefore a medical service constituting the practice of medicine. It requires an order/prescription from a physician, physician assistant, or APRN with prescriptive authority, and administration by a registered nurse or other qualified person under delegation and physician supervision consistent with Rule 800 and the Nurse Practice Act.

Question 9

Does a med spa have to register or hold a license in Colorado?

Accepted Answer

Colorado does not have a med-spa-specific facility license or registration. Med spas are regulated indirectly through the licenses and delegated authority of the individual practitioners and through the physician-delegation rules; the rule requires only that medical-aesthetic services be delivered in a facility 'appropriate to the delegated service provided' and listed on the written delegation agreement, and that the office post the delegating physician's name and contact information. There is no separate state med-spa operating permit.

Question 10

What are the penalties for practicing outside scope in Colorado?

Accepted Answer

Performing medical-aesthetic services without a license or outside the requirements of Rule 800 is the unlicensed practice of medicine, which is subject to a Colorado Medical Board cease-and-desist order, injunctive proceedings, and criminal liability; a delegating physician who fails to comply with Rule 800 may be found to have committed unprofessional conduct and disciplined. Under current statute (C.R.S. 12-240-135), unauthorized practice is subject to penalties under 12-20-407, and enumerated fraudulent acts (such as practicing under a false name or presenting another's credentials) are a class 6 felony.

Colorado Med Spa Regulations