Who can inject — by State
48 of 51 states allow RNs to inject
48 of the 51 US jurisdictions (50 states plus the District of Columbia) allow RNs to inject; the remaining 3 do not. The table below gives each state's rule in its own words, with the statute or board rule it comes from.
Who can inject in all 51 US jurisdictions
| State | Who can inject |
|---|---|
| Alabama | Alabama has no med-spa-specific statute; the Board of Medical Examiners treats cosmetic botulinum-toxin injection as the practice of medicine. Neuromodulators may be administered only by a physician (MD/DO) or by a CRNP or PA acting under a Board-approved cosmetic injection protocol and a collaboration/registration agreement. The Board has expressly declined to authorize delegation of injections to registered nurses or any other person, warning that a conflicting Board of Nursing declaratory ruling may provide no legal protection. |
| Alaska | Alaska has no med-spa-specific statute. Cosmetic injectables (botulinum toxin, dermal fillers) fall under the Medical Board rule 12 AAC 40.967(32), which makes it unprofessional conduct to permit their administration by anyone who is not 'an appropriate health care provider trained and licensed under AS 08' — i.e., physicians (MD/DO) and physician assistants under AS 08.64, and registered/advanced-practice nurses under AS 08.68. An RN administers injectables executing a medical regimen prescribed by an authorized prescriber (AS 08.68.850(11)(D)), while an APRN (nurse practitioner) is a licensed independent practitioner who may diagnose, prescribe, and administer. |
| Arizona | Arizona has no med-spa-specific statute, so injecting authority flows from the boards' practice acts and the Board of Nursing's Advisory Opinion on Medical Aesthetic Procedures (rev. Jan 2025). Physicians (MD/DO), nurse practitioners (APRNs), and PAs may inject as licensed prescribers, and RNs may administer neuromodulators (Botox), dermal fillers, sclerotherapy, PRP, and thread lifts as Level III procedures only pursuant to an order issued by a specifically trained licensed practitioner; appropriately trained LPNs may perform certain Level III procedures only with onsite RN/LP supervision. Estheticians, cosmetologists, and laser technicians may not perform injections. |
| Arkansas | Cosmetic injectables (Botox, dermal fillers) are the practice of medicine in Arkansas. They may be performed by a physician (MD/DO), an APRN with prescriptive authority, or a physician assistant acting under a supervising physician's delegation; a registered nurse (RN) may administer injections only pursuant to a patient-specific order (standing orders permitted) written by a delegating physician or supervising APRN. The Board of Nursing expressly places aesthetic procedures outside the scope of an LPN or licensed psychiatric technician nurse. |
| California | California has no med-spa-specific statute; injecting Botox or dermal filler is the practice of medicine (BPC 2052). Physicians (MD/DO) may inject directly; NPs and PAs may inject within their scope under standardized procedures or a practice agreement (BPC 2836.1, 3502); RNs may inject only under physician delegation and a standardized procedure or patient-specific order issued after a good faith exam (BPC 2725). LVNs, medical assistants, and estheticians may not inject. |
| Colorado | 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. |
| Connecticut | Connecticut's med-spa statute (CGS § 19a-903c) classifies cosmetic injections, neurotoxins, and soft-tissue fillers as 'cosmetic medical procedures' that may be performed only by a physician (MD/DO) or physician assistant licensed under Chapter 370, an advanced practice registered nurse licensed under Chapter 378, or a registered nurse licensed under Chapter 378. Estheticians and unlicensed medical assistants are not authorized to inject. |
| Delaware | Injectable cosmetic treatments are the practice of medicine: physicians (MD/DO) may perform them, APRNs have full independent authority to prescribe, procure, administer and dispense within their role (24 Del.C. § 1935), and physician associates (PAs) may do so under a collaborating physician. Registered nurses may administer injections pursuant to a valid order from an authorized prescriber but cannot independently order/prescribe. There is no Delaware statute assigning aesthetic injections to any other role. |
| 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. |
| Florida | Florida has no med-spa-specific injector statute; authority flows from each profession's practice act. Physicians (MD, ch. 458 / DO, ch. 459) may inject; APRNs/NPs may prescribe, administer, and order any drug within an established written protocol with a supervising physician (464.012); PAs may be delegated authority to prescribe and to administer/order medications under physician supervision (458.347); and RNs may administer injectables such as neurotoxins and fillers, but only as treatments prescribed or ordered by an authorized prescriber who has evaluated the patient (464.003). |
| Georgia | Georgia has no med-spa-specific statute; the Composite Medical Board's FAQ position governs. Cosmetic injections (botulinum toxin, soft-tissue fillers) may be performed by physicians (MD/DO), PAs with a Board-approved job description and Additional Duty Request, APRNs/NPs with a Board-approved nurse protocol agreement and Form C, and RNs (who have no prescriptive authority but may inject with appropriate training and a written order from a physician). Physicians may not delegate injections to medical assistants or other unlicensed persons, and doing so is defined as Unprofessional Conduct. |
| Hawaii | In Hawaii, injecting prescription drugs such as botulinum toxin and dermal fillers is the practice of medicine (HRS 453-1) or advanced nursing. Physicians and osteopathic physicians may prescribe and inject, APRNs have independent authority to prescribe and administer legend drugs (HRS 457-8.6), and physician assistants may inject under physician direction and control (HRS 453-2(b)(4), 453-5.3). A registered nurse may administer injections pursuant to a valid order from a physician, APRN, or PA (HRS 457-2) but cannot independently prescribe. |
| Idaho | Injecting neuromodulators and dermal fillers is the practice of medicine in Idaho and, under the Board of Medicine cosmetic-treatment rules, may be performed only by a physician (MD/DO) or by 'medical personnel' acting under a supervising physician who accepts full responsibility, using exclusively non-incisive and non-ablative prescriptive products. NPs (APRNs) and PAs act within their own prescriptive authority; RNs and other medical personnel administer under a supervising physician's order and oversight. Idaho has no med-spa-specific statute, so this is governed by the general Medical Practice Act and Board of Medicine rules. |
| Illinois | Injecting botulinum toxin, dermal fillers, and weight-loss or vitamin injections is the practice of medicine in Illinois. A physician licensed to practice medicine in all its branches (MD/DO) may perform and prescribe these, and a full-practice-authority APRN may prescribe and administer legend and controlled drugs within scope; a physician may delegate the administration to a physician assistant, registered nurse, or other trained person within a physician-patient relationship, so an RN or PA injects only under physician delegation. |
| Indiana | Botulinum toxin and dermal fillers are prescription drugs, so they must be ordered/prescribed by a physician (MD/DO), an advanced practice registered nurse with prescriptive authority, or a physician assistant with delegated prescriptive authority — the three license types SB 282 defines as a med-spa 'practitioner.' A registered nurse may administer the injection pursuant to a valid order because 'registered nursing' includes executing a regimen delegated by a physician (IC 25-23-1-1.1(b)(5)), but an RN cannot independently prescribe or order the product. Indiana has no statute expressly naming who may inject cosmetic injectables, so this is derived from prescribing law plus nursing scope, and some commentators read Indiana as excluding RNs. |
| Iowa | Under Iowa Board of Medicine rule 653—13.8, performing medical aesthetic services — expressly including injectables, Botox injections, and collagen injections — is the practice of medicine. A physician (MD/DO) may perform them directly, or delegate them to a 'qualified licensed or certified nonphysician person' who acts within that person's own license/certification scope under the physician medical director's supervision. ARNPs (NPs) independently prescribe and administer prescription drugs and devices (655—7.4(3)); PAs and RNs may inject under delegation and supervision. |
| Kansas | Injecting a patient for a therapeutic or cosmetic purpose is the practice of the healing arts under K.S.A. 65-2869 (diagnosing and furnishing/administering drugs), so the decision to inject must be made by a licensed prescriber: a physician (MD/DO), an APRN who since July 2022 has independent prescriptive authority (K.S.A. 65-1130), or a physician assistant acting under a supervising physician (K.S.A. 65-28a02). An RN (or other qualified person) may physically administer the injection, but only pursuant to a valid order or lawful delegation from a prescriber, not on the RN's own judgment — Attorney General Opinion 94-142 confirms non-physicians may 'administer' drugs under a practitioner's direction while independent diagnosis/dispensing is reserved to the licensee. |
| Kentucky | Injectables (neuromodulators, dermal fillers) are the practice of medicine: only a physician (MD/DO), physician assistant, or APRN has the statutory authority to diagnose the patient and decide to administer medication by injection, and Kentucky APRNs may order and stock nonscheduled legend drugs for that purpose (prescriptive authority requires a collaborative agreement, with independence for non-scheduled drugs after four years' experience). RNs and LPNs may administer an injection only when it is lawfully ordered by one of those prescribers as part of a documented medical plan of care — RNs may administer neuromodulators and fillers under supervision while LPNs are limited to neuromodulators under direct supervision — and no nurse may independently order products or prescribe. |
| Louisiana | Injecting neurotoxins and fillers is the practice of medicine, so it may be ordered/performed by physicians (MD/DO), and by NPs and PAs practicing with a physician; a qualified NP with a board-approved collaborative practice agreement may perform cosmetic injections independently as a subspecialty. A trained RN may inject FDA-approved neurotoxins (e.g., Botox) when ordered by a qualified prescriber with a physician or NP physically present, but the Board of Nursing expressly excludes ALL dermal fillers (collagen, Restylane, Juvederm, etc.) from the RN scope. Estheticians and medical assistants may not inject. |
| Maine | Maine has no med-spa-specific injectables statute; authority flows from the general practice acts. Physicians (MD/DO), nurse practitioners, and physician assistants may order and administer cosmetic injectables within their scope, and a registered nurse may administer injections pursuant to the order of a legally authorized prescriber (32 MRS 2102 'execution of the medical regimen as prescribed'). Estheticians and unlicensed staff may not inject. |
| Maryland | Maryland has no injector-specific med-spa statute; injections are 'cosmetic medical procedures' governed by the Board of Physicians (COMAR 10.32.09). A Maryland-licensed physician (MD/DO) may perform them or delegate to a physician assistant, or assign to any other licensed health care provider — a nurse practitioner (CRNP) under their own advanced-practice scope, or a registered nurse by delegation — whose own licensing board has determined the procedure falls within that provider's scope of practice. |
| Massachusetts | Injectables (neuromodulators, dermal fillers) are the practice of medicine, so they must be prescribed/ordered by a physician (MD/DO), nurse practitioner, or physician assistant and may be administered by a registered nurse under a valid order and delegation. 243 CMR 2.07(4) provides that there shall be no delegation of medical services to an individual not licensed to perform them, so unlicensed staff and estheticians may not inject. Massachusetts nurse practitioners have full practice authority (independent to prescribe after two years of supervised practice under 244 CMR 4.07). |
| Michigan | Michigan has no med-spa-specific injection law; injecting Botox or dermal filler is the practice of medicine governed by the Public Health Code. A physician (MD under part 170 or DO under part 175) may inject directly or, under MCL 333.16215, delegate the act to a licensed or unlicensed individual (e.g., NP, PA, RN, or trained aesthetic staff) who is qualified by education, training, or experience and works under the physician's supervision. Nurse practitioners (APRNs) may prescribe the non-controlled prescription drug themselves under MCL 333.17211a and PAs may prescribe under a practice agreement per MCL 333.17548, while an RN administers only as a delegated act. |
| Minnesota | Prescribing and administering drugs is the practice of medicine, so the decision to inject (e.g., neuromodulators or fillers) must be made by a physician (MD/DO), an advanced practice registered nurse, or a physician assistant, each acting within their prescribing authority. A registered nurse may physically administer the injection only under a licensed practitioner's direction and supervision or a valid prescriber order — an RN cannot independently order the treatment. There is no Minnesota statute specific to cosmetic injections; the rule flows from the Medical Practice Act, the APRN/PA acts, and the legend-drug statute. |
| Mississippi | Botulinum toxin and dermal-filler injections are the practice of medicine, so physicians (MD/DO) may inject; appropriately prepared nurse practitioners (specifically FNPs, ACNPs, ANPs/AGNPs and CRNAs) may inject under a collaborative agreement in which the collaborating physician has examined the patient and documented chart approval; and physician assistants may inject as a delegated medical service under a Board-approved supervising-physician protocol. Registered nurses and LPNs may NOT perform Botox or filler injections in Mississippi. |
| Missouri | Missouri has no med-spa statute; injecting neuromodulators and dermal fillers is the practice of medicine performed by physicians (MD/DO). Advanced practice registered nurses and physician assistants may administer, dispense, and prescribe such drugs and provide treatment only under a written collaborative practice arrangement with a collaborating physician, and a registered nurse may administer an injection under that authorized prescriber's order. Estheticians and other unlicensed persons may not inject. |
| Montana | Montana has no med-spa-specific injectables statute; administering neurotoxins or dermal fillers is the practice of medicine or nursing, so it may be performed only by a physician (MD/DO), a physician assistant, or an advanced practice registered nurse, or by a registered nurse administering the drug under an authorized prescriber's order. The Board of Barbers and Cosmetologists confirms that injectables fall outside every cosmetology and esthetics license and that a qualified health care provider must prescribe the product and either provide or appropriately supervise the injection. |
| Nebraska | Administering cosmetic injectables (neurotoxins, dermal fillers) is the practice of medicine in Nebraska, which only licensed physicians (MD/DO) may perform; nurse practitioners/APRNs may inject and prescribe within their specialty, and physician assistants may inject as a delegated medical service under physician supervision. A registered nurse may administer an injection pursuant to a valid order from a prescriber but cannot independently prescribe or order the drug. Nebraska has no med-spa-specific injector statute — authority flows from the general Medicine and Surgery Practice Act and the APRN/PA practice acts. |
| Nevada | Nevada limits who may inject dermal or soft-tissue fillers by statute (NRS 629.086) to physicians and physician assistants (NRS ch. 630 allopathic and ch. 633 osteopathic), registered nurses, advanced practice registered nurses, and — with board-prescribed training — dentists and podiatric physicians, and only within scope and at a medical facility or licensed provider's office. Neuromodulators and other injectables are dangerous drugs requiring a prescriber's order; the Board of Nursing classifies cosmetic injectables (neuromodulators, fillers, biostimulators) as within a registered nurse's scope only under direct supervision and out of an LPN's scope. |
| New Hampshire | Injecting cosmetic drugs is the practice of medicine (diagnosing, treating, prescribing) under RSA 329:1, so it must be performed or ordered by a licensed prescriber. Physicians (MD/DO), APRNs/nurse practitioners (who have plenary authority to prescribe and administer drugs under RSA 326-B:11), and physician assistants (who may prescribe and administer drugs under RSA 328-D:3-b) all qualify; a registered nurse may administer an injectable pursuant to that prescriber's order as part of registered nursing practice (RSA 326-B:2, XI), and RSA 313-A:25 confirms nurses act within their own professional scope, not cosmetology licensure. |
| New Jersey | New Jersey has no aesthetics-specific injector statute; Botox and dermal fillers are treated as the practice of medicine, so they may be prescribed and administered by physicians (MD/DO) and by nurse practitioners (APNs) and physician assistants acting under a collaborating/supervising physician. Registered nurses may administer the injection under a physician's or APN's order, but certified medical assistants are limited to routine injections and are expressly barred by the Board from providing cosmetic 'treatments.' |
| New Mexico | Injecting cosmetic or aesthetic substances is defined by rule as the practice of medicine and may not be delegated to unlicensed medical assistants (16.10.13.9 NMAC). It may be performed by physicians (MD/DO), APRNs/nurse practitioners (independently, with appropriate population foci, licensure, national certification and education), physician assistants (who may prescribe and administer dangerous drugs and Schedule II-V controlled substances under physician supervision/collaboration), and registered nurses only when delegated by and under the indirect supervision of an APRN. LPNs may perform aesthetic procedures under direct supervision but may NOT perform aesthetic injections (16.12.14.8.F NMAC). |
| New York | Injecting neurotoxins (Botox) and dermal fillers is the practice of medicine in New York (Education Law §6521), so it may be performed by a physician (MD/DO) and by a nurse practitioner or physician assistant acting within their delegated/collaborative medical scope. A registered nurse may administer the injection only by executing a patient-specific order from a physician, NP, or PA following an appropriate examination; estheticians and cosmetologists may not inject, and the Department of State's med-spa chart classifies injectables as requiring a medical (not appearance-enhancement) license. |
| North Carolina | Neuromodulator (Botox) and dermal filler injections are cosmetic/aesthetic medical procedures in North Carolina. Physicians (MD/DO), nurse practitioners, and physician assistants may evaluate the patient, order, and personally perform the injection; RNs may perform the injection pursuant to an order from a prescriber (physician, NP, PA, or other practitioner with prescriptive authority) who has completed the patient evaluation. LPNs may inject only with on-site supervision by an RN, physician, NP, or PA. |
| North Dakota | Injecting FDA-approved aesthetic agents (e.g., botox, dermal fillers) requires prescriptive authority to order it and licensed-nurse competency to administer it: the prescriber must be a physician (MD/DO), physician assistant, or APRN with prescriptive authority, and an RN with comprehensive accredited aesthetics training may inject only under that prescriber's specific order. LPNs are outside this guidance and cosmetologists/estheticians are expressly prohibited from injections and dermal fillers. |
| Ohio | Administering a prescription injectable (neurotoxin or dermal filler) is administering a drug, which in Ohio may be done by physicians (MD/DO), and by certified nurse practitioners, clinical nurse specialists, and physician assistants who hold prescriptive authority. Registered nurses do not prescribe but may administer injectables pursuant to a valid, current order from an authorized prescriber; unlicensed persons generally may not inject prescription drugs because such administration involves medical judgment and, if delegated, would require on-site physician supervision. |
| Oklahoma | Oklahoma has no med-spa-specific statute; the Medical Board's and Osteopathic Board's Medical Spa Guidelines govern, treating injection of neuromodulators and dermal fillers as a medical procedure. A supervising MD or DO, or a supervised PA or supervised APRN (NP) with prescriptive authority, must establish the physician/patient relationship and may then perform the injection or delegate it to a licensed RN under general supervision. LPNs, licensed estheticians, medical assistants, and unlicensed assistants may perform delegated treatment only under the physician's direct, physically-available supervision. |
| Oregon | Administering injectable cosmetics (Botox, dermal fillers) is the practice of medicine under ORS 677.085, so it may be performed by physicians (MD/DO), physician associates, and nurse practitioners/APRNs, and by registered nurses only pursuant to a valid order from an authorized prescriber and within the RN's individual scope. Naturopathic physicians with prescribing authority may also do so. Estheticians and other unlicensed staff may not inject: the Oregon Health Authority's Health Licensing Office, together with the Boards of Cosmetology and Certified Advanced Estheticians, has confirmed injection is outside the scope of esthetics and is the practice of medicine. |
| Pennsylvania | Pennsylvania has no med-spa-specific statute; injecting neuromodulators and dermal fillers is the practice of medicine that a physician (MD or DO) may perform or delegate. An RN may administer an injectable only pursuant to a valid order (49 Pa. Code § 21.14); PAs act under a supervising physician and CRNPs act in collaboration with a physician, each injecting within their authority and training. Delegation to any non-physician must meet the acceptable-practice and competency conditions of the Medical Practice Act § 17 and 49 Pa. Code § 18.402. |
| Rhode Island | Cosmetic injections (neurotoxins/Botox and soft-tissue dermal fillers) are 'cosmetic medical procedures' under Rhode Island's Medical Spas Safety Act (RIGL ch. 23-105) and may be performed directly by a physician (MD/DO), a physician assistant, or a certified nurse practitioner/APRN. The Act's own definitions section states a cosmetic medical service 'shall be performed by a delegate only if the services are within the scope of the delegate' and has been delegated by a medical director/supervising physician/PA/CNP -- delegation does not by itself enlarge a licensee's existing scope of practice. RIDOH's official scope-of-practice chart (Guidance Re: Medical Spa and IV Therapy Businesses) lists registered nurses as 'No' for both Neuromodulators (Botox) and Dermal Filler -- unchanged between its original 2024 issuance and its most recent available republication -- meaning cosmetic injection is not currently recognized as within an RN's scope of practice in Rhode Island. Because the statutory delegate framework defers to (rather than expands) existing scope, and RIDOH has not recognized Botox/filler injection as within RN scope, RNs are not established as authorized cosmetic injectors under current law and guidance; only physicians, PAs, and CNPs/APRNs are supported. (RIDOH must issue implementing regulations by July 1, 2026, which could revisit scope determinations; a small number of law-firm summaries loosely describe RNs as receiving 'delegated cosmetic injection authority' under the Act, but that reading is in tension with RIDOH's own scope chart and is not a settled interpretation.) |
| South Carolina | Diagnosing a patient and deciding to give an injectable medication is the practice of medicine, so only a physician (MD/DO), a physician assistant practicing with a supervising physician, or a nurse practitioner/certified nurse-midwife/clinical nurse specialist with prescriptive authority and a collaboration (practice) agreement may order or prescribe an injection. A registered nurse may prepare and administer the injection only pursuant to a valid order from one of those authorized prescribers; an RN who assesses, selects, and administers injectables on his or her own is engaged in the unlicensed practice of medicine. |
| South Dakota | South Dakota has no med-spa-specific statute; cosmetic injection is regulated as the practice of medicine under SDCL 36-4-9, so physicians (MD/DO) and — with prescriptive authority — nurse practitioners and physician assistants may inject and serve as the 'authorized medical provider' who orders and delegates. Under the SD Board of Nursing's dermatological-procedures advisory opinion, a registered nurse (and a licensed practical nurse under direct supervision) may administer FDA-approved injectable neurotoxins such as Botox as a delegated act, but dermal fillers are expressly excluded from RN/LPN scope — so fillers must be injected by a physician, NP, or PA. |
| Tennessee | Injecting neuromodulators and dermal fillers is the practice of medicine in Tennessee, so it may be performed by a physician (MD/DO) or delegated to an NP or PA who holds prescriptive authority and is working under the required physician collaboration/supervision. An RN may administer or inject only pursuant to a valid order from a prescriber and cannot serve as the prescriber. There is no separate 'who may inject' statute; authority flows from the Medical Practice Act, the medical-spa registration rule, and the APRN/PA scope rules. |
| Texas | Injecting cosmetic products such as botulinum toxin and dermal fillers is the practice of medicine in Texas. A physician (MD/DO) may perform the injection or delegate it; physician assistants and APRNs (nurse practitioners) may inject under a physician's delegation and prescriptive authority, and an RN (or other qualified, properly trained person) may administer the injection under physician delegation and written protocol. The provider who performs the good-faith exam and orders the treatment must be a physician, PA, or APRN — not an RN or esthetician. |
| Utah | Injecting neuromodulators or dermal fillers is 'administering' a prescription drug/device and part of the practice of medicine and nursing, so it must be ordered by a licensed prescriber: a physician (MD/DO), an advanced practice registered nurse (APRN/NP, who has independent prescriptive authority in Utah), or a physician assistant (working under a collaborative practice arrangement with a supervising physician). A registered nurse may perform the injection under a prescriber's order or delegation, but estheticians, medical assistants, and other unlicensed staff may not inject. |
| Vermont | Vermont has no med-spa-specific injector statute; administering drugs (including cosmetic injectables like neurotoxins and dermal fillers) is the 'practice of medicine' under 26 V.S.A. § 1311, so it is performed by licensed physicians (MD/DO) and lawfully delegated to advanced practitioners. APRNs (nurse practitioners) may prescribe and administer independently once they complete the transition-to-practice requirement (24 months and 2,400 hours), and before that under a collaborative provider agreement (§ 1613); physician assistants may 'prescribe, dispense, administer, and procure drugs and medical devices to the same extent as may a physician' under a written practice agreement (§ 1735a(h)). Registered nurses may administer injections pursuant to an authorized prescriber's order but cannot independently order/prescribe the drug. |
| Virginia | Injecting neuromodulators and dermal fillers is the practice of medicine because it involves administering prescription drugs. It may be performed by a physician (MD/DO), or by a nurse practitioner or physician assistant acting within a practice agreement and scope, and a physician (or NP/PA) may delegate the injection to a registered nurse or other properly trained, supervised person under Va. Code § 54.1-2901, which expressly authorizes nurses and technicians to give injections under the orders of a licensed physician, osteopath, APRN, or PA and permits delegation of nondiscretionary functions. Virginia has no med-spa-specific statute, so this flows from the general Medical Practice Act and the delegation/prescribing statutes. |
| Washington | Cosmetic injection of medication or substances is the practice of medicine in Washington. MDs and DOs may inject, ARNPs (nurse practitioners) may prescribe and inject independently, PAs may inject under their Medical-Commission-approved practice agreement, and a physician may delegate the injection to a properly trained registered nurse or licensed practical nurse under WAC 246-919-606. RNs must have an order/prescription from an authorized prescriber and be delegated the task; they cannot self-prescribe the injectable. |
| West Virginia | Injecting neuromodulators and dermal fillers is the 'practice of medicine and surgery' under W. Va. Code §30-3-4(3) (the diagnosis, treatment, operation, or prescription for a physical condition), so it must be performed by a licensed physician (MD or DO) or delegated to an advanced practice registered nurse (nurse practitioner) or physician assistant acting within scope. A registered nurse may inject only as an administering agent 'as prescribed by a licensed physician... or a licensed advanced practice registered nurse' (§30-7-1) — an RN cannot independently evaluate, order, or prescribe the injectable. West Virginia has no med-spa-specific statute; this flows from the general Medical Practice Act and Nurse Practice Act. |
| Wisconsin | Only a person licensed to practice medicine and surgery may practice medicine in Wisconsin; injecting prescription drugs (e.g., neurotoxins, fillers) is a medical act that physicians (MD/DO) may perform directly and that advanced practice nurse prescribers (NP/CNS/CRNA) and physician assistants may perform under their prescribing authority. Registered nurses may administer injections as a delegated act performed pursuant to a provider's order or protocol under the delegating provider's supervision. Note: as of this review date APRN prescribers must practice in collaboration with a physician; the APRN independent-practice provisions of 2025 Wisconsin Act 17 do not take effect until September 1, 2026. |
| Wyoming | Injecting prescription products (e.g., neurotoxins, dermal fillers) is the practice of medicine because it involves prescribing/administering prescription drugs and treating a condition (W.S. 33-26-102(a)(xi)(B),(E)). Physicians (MD/DO) may inject; APRNs may independently prescribe and administer prescriptive medications with no required supervision (W.S. 33-21-120(a)(i)(A); WSBN); PAs practice medicine and may prescribe/administer (W.S. 33-26-502(b), 33-26-510(c)); and RNs may administer/inject drugs prescribed by an authorized prescriber as execution of the medical regimen (W.S. 33-21-120(a)(xi)). |
Methodology & sources
Every entry is compiled from that state's own statutes, medical- and nursing-board rules, and official guidance, and each state page links the primary source behind its wording. Last reviewed 2026-07-21. Download the full dataset as CSV.
Citing this page? Use: MedSpa Standards, "Who can inject by State for Med Spas," retrieved 2026-07-21, https://medspastandards.com/med-spa-regulations-by-state/who-can-inject
Build a compliant med spa faster
Board-ready SOPs and compliance checklists mapped to these requirements.
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.