As individuals across the country become increasingly focused on their health and wellness, the 20-billion-dollar med spa industry continues to grow. Patients are now visiting their med spa more than their primary care provider.1 As a result, state regulators are paying closer attention to the services provided in such establishments and the requirements related to the same in an effort to ensure public safety and protect practitioner licenses.
It is important to establish that the use of prescriptive medical devices and injections for cosmetic purposes is considered the practice of medicine and nursing and as result, is held to the same standards as administration and prescription of other medical devices and medications. Therefore, med spas should consider taking steps to ensure compliance with state requirements and restrictions related to issues such as licensure, corporate practice of medicine, scope of practice, informed consent, supervision, delegation, prescriptive practices, and fee splitting.
Some state licensing agencies have issued guidance, advisory opinions, or position statements specific to the med spa industry. These instructive documents help providers and entities in such states uncover compliance focus areas and those outside of the state identify industry best practices. It is impossible to capture the full statutory and regulatory landscape surrounding med spas in one sitting. We hope to break down important focus areas over a series of articles. This first article focuses specifically on state requirements related to what are commonly referred to as good faith examinations (“GFEs”) prior to administering medical aesthetic treatments.
GFE requirements ensure that a health care practitioner with prescriptive authority, such as a physician or advanced practice providers, reviews the patient’s medical history and performs a physical exam to determine whether the patient is a good candidate for a particular treatment or prescription product. These exams are critical to establishing a practitioner-patient relationship which is generally required before administering any prescription drug or utilizing a prescription device. States vary on whether the GFE can be performed via telehealth, when it must be performed, and who can perform the exam. As a result, it’s important to check your state’s statutes, regulations, and licensing board guidance related to telehealth, prescriptive practices, and establishing practitioner-patient relationships.
Please see a few examples of med spa specific guidance that states have issued below related to GFEs. Because many medical aesthetic procedures are performed by nurses acting under standing protocols, many of the guidance documents below were issued by state nursing boards and thus, do not address the authority of other advanced practice providers like physician assistants that are governed by other regulatory boards.
Helpful Tips
To obtain guidance on GFEs in your state, it is important to check the state’s medical and nursing board websites for advisory opinions, position statements, and policies. If the boards do not have specific guidance documents, check to see if the statutes and/or regulations governing physicians, nurses, and/or physician assistants outline requirements for establishing practitioner-patient relationships prior to prescribing medications or conducting treatments or procedures. As noted above, most states will require the practitioner to conduct some sort of medical history review and physical examination prior to issuing or administering a prescription product or conducting a procedure.
The practitioner-specific state statutes and regulations may address whether such relationship can be formed via telehealth. However, it is also important to check your state’s telehealth/ telemedicine statutes and regulations for parameters surrounding what types of technology can be used, informed consent requirements, and any specifics regarding the type of exam that must be conducted (e.g. synchronous or asynchronous). Finally, if your state does not define the frequency for conducting GFEs, a general best practice is at least annually to ensure that the practitioner is accounting for any changes in the patient’s condition or history that could impact the appropriateness and safety of the ongoing treatments.
Always ensure that GFEs and the subsequent order for prescription products are documented in the patient’s record. The more detail the practitioner can provide that supports their determination that the patient is an appropriate candidate for the prescribed treatment or procedure, the better. Make sure to ask the patient at subsequent visits whether there has been any change in their medical conditions or history and document the same.
END NOTES
1 American Society for Dermatologic Surgery, Inc., Trends in Medical Spa Statistics and Patient Safety (Feb. 2024), available here.
2 Arizona Board of Nursing, Advisory Opinion, Medical Aesthetic Procedures (Jan. 2025), available here.
3 Medical Board of California, The Bottom Line: The Business of Medicine – Medical Spas (2009), available here.
4 Kentucky Board of Nursing, Advisory Opinion Statement (Oct. 2023), available here.
5 Louisiana State Board of Nursing, Declaratory Statement (Mar. 2011), available here.
