District of Columbia Med Spa Regulations
The District of Columbia has no dedicated med-spa statute; under the DC Board of Medicine's Aesthetic Medicine Policy (No. 15-02), cosmetic injectables and lasers are deemed the practice of medicine that must be delivered within a physician-owned/physician-led medical practice with a physically present medical director, while nurse practitioners hold full independent practice authority.
Last reviewed: 2026-07-21
Who can inject Botox and dermal fillers in District of Columbia?
Cosmetic injectables — neuromodulators (Botox), tissue fillers, and sclerotherapy — are classified as Level III aesthetic procedures that 'constitute the practice of medicine' under the DC Board of Medicine's Aesthetic Medicine Policy, so they may only be ordered/performed by a licensed medical practitioner. Physicians (MD/DO), nurse practitioners (who hold independent statutory authority to perform medical diagnosis, treatment, and prescription), and physician assistants (in collaboration with a physician) may prescribe and administer them; an RN may administer under a valid order after the required patient evaluation.
Source: DC Board of Medicine Policy No. 15-02, Policy on the Practice of Aesthetic Medicine (Nov. 13, 2014), §§ 1.4(d), 1.10, 1.19, D.C. Code § 3-1201.02 (Definitions of health occupations — practice of medicine; physician assistant practice), D.C. Code § 3-1206.01 (Advanced practice registered nursing — general authorization: medical diagnosis, treatment, prescription)
Does District of Columbia require a good-faith exam before treatment?
Before providing treatment or prescribing medication, a physician (or authorized prescriber) must perform a patient evaluation adequate to establish a diagnosis and identify contraindications (Board of Medicine Telemedicine Policy §§ 1.3, 1.6, referencing the binding rule 17 DCMR § 4618.7). The evaluation need not be in person — where there is no prior face-to-face interaction, the practitioner may establish the relationship and perform the evaluation via real-time auditory, or real-time visual and auditory, telemedicine (§ 1.8).
Source: DC Board of Medicine Policy No. 15-01, Telemedicine Policy (Nov. 29, 2014), §§ 1.3, 1.6, 1.8
Does a med spa in District of Columbia need a medical director?
Any facility performing Level II or Level III aesthetic procedures (lasers, injectables, deep peels) must employ a medical director, a clinical director, and a site director (which may be the same person). The medical director must be a duly-credentialed MD or DO with training sufficient to supervise the procedures and must be physically present in the medical spa for at least 50% of the facility's weekly operating hours.
Can a non-physician own a med spa in District of Columbia?
The Board of Medicine's Aesthetic Medicine Policy defines a 'medical spa' as an entity that is owned by — or of which the majority of shares are held by — a physician(s) licensed in the District that provides aesthetic medical services. DC therefore effectively requires physician ownership/control of a med spa, though this appears in a Board policy that is expressly 'directive in nature and not mandatory' rather than in a codified corporate-practice-of-medicine statute.
What supervision does District of Columbia require for med-spa procedures?
Level II/III procedures must be performed within a medical practice overseen by a medical, clinical, and site director, with the medical/clinical director physically present for at least 50% of operating hours and the site director present during all hours (or a qualified substitute). Nurse practitioners may practice and prescribe independently (the former collaboration/protocol requirements at §§ 3-1206.02 and 3-1206.03 were repealed), physician assistants practice 'in collaboration with' a licensed physician, and RNs and other delegatees act under a licensed practitioner's order/supervision.
Source: DC Board of Medicine Policy No. 15-02, Policy on the Practice of Aesthetic Medicine, §§ 1.11-1.17, D.C. Code § 3-1201.02 (physician assistant practice — 'in collaboration with a licensed physician'), D.C. Code § 3-1206.01 (APRN general authorization; former collaboration/protocol subsections repealed)
What can an esthetician legally do in District of Columbia?
Estheticians and cosmetologists are limited to Level I, low-risk, non-medical services (e.g., superficial microdermabrasion above the stratum corneum, superficial peels of ≤20% concentration and pH ≥3.0, waxing, facials, LED/low-level light). The DC cosmetology rules expressly exclude removing superfluous hair 'by means of laser procedures or intense pulsed light' from basic esthetics and limit it to cosmetic, non-medical purposes; a master esthetician may perform otherwise-medical procedures only under the supervision of a licensed health care practitioner acting within scope.
Source: 17 DCMR § 3799 (Barber and Cosmetology — Definitions: 'basic esthetics' excludes laser/IPL hair removal and medical treatment), DC Board of Medicine Policy No. 15-02, Policy on the Practice of Aesthetic Medicine, §§ 1.2, 1.5-1.6, 1.10
Who can operate a cosmetic laser in District of Columbia?
Laser and IPL hair removal and skin treatment are Level II procedures, and ablative/vaporizing lasers are Level III; both 'constitute the practice of medicine' and must be performed within a physician-led medical practice with a physically present medical director. They may be performed by a physician, or by an NP or PA within scope, or by an RN/trained delegate under that licensed practitioner's supervision — not by an unsupervised esthetician.
What are the rules for IV therapy and vitamin drips in District of Columbia?
DC has no med-spa- or IV-therapy-specific statute; intravenous administration of fluids or vitamins falls within the practice of medicine and the practice of nursing. It requires a valid order from a physician, NP, or PA (who may prescribe and 'select, administer, and dispense therapeutic measures') following an adequate patient evaluation, with administration by a physician, NP, PA, or RN acting within the nursing scope.
Source: D.C. Code § 3-1201.02 (definitions — practice of medicine/nursing; administering treatment), D.C. Code § 3-1206.04 (APRN authorized acts — initiate, monitor, and alter drug therapies; initiate therapies/treatments)
Does a med spa have to register or hold a license in District of Columbia?
DC has no dedicated med-spa license or registration; med spas are regulated as medical practices under the Board of Medicine, which issued its Aesthetic Medicine Policy expressly 'until the Board promulgates regulations governing the practice of medicine in medispas.' Each practitioner must hold the appropriate DC health-occupation license (§ 3-1205.01), and any facility performing Level II/III procedures must have the required medical/clinical/site directors and physician ownership.
Source: DC Board of Medicine Policy No. 15-02, Policy on the Practice of Aesthetic Medicine (intro; §§ 1.8-1.11), D.C. Code § 3-1205.01 (license, registration, or certification required to practice a health occupation)
What are the penalties for practicing outside scope in District of Columbia?
No person may practice, attempt to practice, or offer to practice a licensed health occupation in DC without the required credential (§ 3-1210.01). Unauthorized practice of medicine — such as injecting or performing laser procedures without a license — is a crime punishable by up to 1 year imprisonment and a fine up to $10,000 for a first violation and up to $25,000 for a subsequent violation (§ 3-1210.07); the District may also pursue injunctions (§ 3-1210.10) and impose alternative civil/administrative sanctions (§ 3-1210.09).
Source: D.C. Code § 3-1210.01 (Practicing without a license, registration, or certification), D.C. Code § 3-1210.07 (Criminal penalties — up to 1 year and $10,000/$25,000)
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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.