Texas physician (MD and DO) CME requirements for license renewal

This guide covers physicians licensed by the Texas Medical Board, which licenses both MDs and DOs under the same rule. The requirements are identical for both degrees; the only practical difference is which credit types you are likely to hold. The Board's CME rule was renumbered in 2025: it is now 22 TAC §161.35 (the old Chapter 166 has been repealed).

The short version

Requirement	Hours	How often	Who
Total CME	48	Every two-year registration	Every MD and DO
Formal credit (within the 48)	at least 24	Every registration	Every MD and DO
Medical ethics and/or professional responsibility	2 (formal)	Every registration	Every MD and DO
Pain management and prescription of opioids	2 (formal)	Within 1 year of licensure, again at the 2nd renewal, then every 8 years	Direct patient care
Human trafficking prevention (HHSC-approved)	1	First renewal period, then every 3rd renewal (every 6 years)	Direct patient care
Forensic evidence collection (task-force approved)	2	Every registration, starting with licenses expiring February 28, 2027	Physicians treating patients in an emergency room setting
Nutrition and metabolic health	1	Every registration, for licenses expiring on or after May 30, 2027	Every MD and DO
Life of the Mother Act course (TMB course)	at least 1	One time	Physicians who provide obstetric care

All of the topic hours count toward the 48; they are not added on top.

How many hours, and what kind

22 TAC §161.35(a) requires 48 CME credits every biennial registration period. The Board says the 24 months run with your registration period, not the calendar year.

At least 24 must be formal credit. The rule lists formal credit as AMA PRA Category 1 designated by:

• the Accreditation Council for Continuing Medical Education (ACCME), or a state medical society recognized by ACCME;
• the American Academy of Family Physicians;
• the AOA Category 1-A;
• the Texas Medical Association;
• the Board, but only for medical ethics and/or professional responsibility; or
• a Board-appointed physician doing a competency evaluation or practice monitoring (1 credit per hour, up to 12).

So AAFP Prescribed credit counts as formal credit in Texas, for MDs and DOs alike. DOs do not need AOA credit: AOA Category 1-A, AMA PRA Category 1 and AAFP Prescribed credit all count toward the 24 formal hours.

Up to 24 hours may be informal: self-study, or hospital lectures, grand rounds or case conferences not approved for formal credit. Under Occupations Code §156.056, half of your informal hours may come from volunteer medical services at a practice serving a medically underserved population (not your own primary practice site).

Carrying hours forward. Up to 48 excess credits may be carried forward, but only to the next registration period (§161.35(c)(2)). The required formal topics — ethics/professional responsibility, human trafficking and pain management/opioids — cannot be carried forward.

Missing hours. Under §161.35(c)(1), "Any CME deficiency can be remedied within 30 days after registration renewal due."

When your license expires

Texas registration is individual, not statewide. According to the Board's renewal page, licenses expire on February 28, May 31, August 31 or November 30. The Board assigns your date when you are licensed. "Even number licenses expire in even number years and odd number licenses expire in odd number years." The first registration permit is 12 or 24 months long; after that, each registration is two years and falls on the same date. There is a 30-day grace period after expiration before a $75 late fee applies (Occupations Code §156.008 and the Board's renewal page). You can renew online starting 60 to 90 days before expiration.

The required topics

Medical ethics and/or professional responsibility — 2 formal hours, every registration

Required by §161.35(a)(2)(B) of every physician. The Board says professional responsibility "includes but is not limited to courses in: Risk management, Domestic Abuse; or Child Abuse," and that the course must be approved for ethics or professional responsibility credit by the accrediting agency. Human trafficking and pain management/opioid hours can also satisfy this requirement (Board FAQ). Since 2016 the Board no longer approves ethics courses itself.

Pain management and the prescription of opioids — 2 formal hours

Occupations Code §156.055 applies to physicians who designate a direct patient care practice when they renew. The Board defines direct patient care as "any in-person or real-time audio or visual communication with a patient or a patient's legal medical decision-maker for the purpose of evaluation, treatment, diagnosis, directly testing or ordering of tests, or reviewing or interpreting of test results." The schedule:

• 2 hours within one year of license issuance, and 2 hours again in the second renewal period;
• after that, 2 hours every 8 years (every 4 renewals). The Board's example: completed for 2024, then exempt in 2026, 2028 and 2030, and due again for 2032.

The course must cover pain management best practices and alternatives, safe and effective pain management with opioids and other controlled substances (standards of care, identifying drug-seeking behavior, communicating with patients), and prescribing and monitoring of controlled substances. The hours count toward the ethics/professional responsibility requirement. They do not count toward the 10 hours required of pain clinic personnel.

Human trafficking prevention — 1 hour, first renewal, then every third

Occupations Code §156.060 also applies to direct patient care. You need 1 hour in the first renewal period after licensure, then once every third renewal period (every 6 years). Only courses approved by the Texas Health and Human Services Commission (HHSC) count. The Board points to HHSC's free course. The hour is designated as ethics/professional responsibility and counts toward the 24 formal hours.

Forensic evidence collection — 2 hours, every registration (emergency room setting)

HB 47 (2025) amended Occupations Code §156.057, and the Board added §161.35(a)(3)(A), effective September 3, 2026. Physicians "whose practice includes treating patients in an emergency room setting" need 2 hours on trauma-informed care for sexual assault survivors, referrals and prophylactic medications, survivors' rights, forensic evidence collection methods, and state law on custody and tracking of evidence. Formal or informal credit counts, but only courses approved by the Governor's Sexual Assault Survivors' Task Force satisfy it. The Board says: "Currently, there is no approved coursework available ... Because of this, the requirement will begin for physicians and physician assistants whose license expire on February 28, 2027." The Board lists specialties likely to be affected (for example emergency medicine and urgent care). Physicians who are not affected attest "Not Working in an ER Setting" in CE Broker.

Nutrition and metabolic health — 1 hour, every registration

SB 25 (2025) added Occupations Code §156.061, and §161.35(a)(3)(B) (effective September 3, 2026) requires 1 credit "in the topic of nutrition and metabolic health focused on the nutritional guidelines recommended by the Texas Nutrition Advisory Committee." Formal or informal credit from an accredited provider counts. The Board says it "applies to licensees whose licenses expire on or after May 30, 2027." A general nutrition course may not be built on the Committee's guidelines, so check before you rely on one.

Life of the Mother Act course — one time (obstetric care)

SB 31 (2025), Section 19, requires physicians who provide obstetric care to complete a course on pregnancy-related medical emergencies "that equals at least one hour of continuing medical education" before initial licensure or before their first renewal after January 1, 2026. "This is a one-time requirement." The Board names the specialties and board certifications it applies to (including obstetrics and gynecology, maternal-fetal medicine, family medicine, emergency medicine and urgent care). Only the Board's free course in MyTMB satisfies it. The Board says that course "is NOT an AMA Category 1 credit" and may be counted only as ethics.

Other role-based requirements

• Pain management clinics: the medical director must make sure all personnel complete 10 hours of pain management CME each biennium (Board rule 172.3).
• EMS (off-line) medical directors: 12 hours of EMS medical direction CME, or an approved alternative, within two years of the role; then 1 hour each renewal (Board rule 169.12).
• Tick-borne diseases: encouraged, not required (Occupations Code §156.059).

The federal DEA requirement (the MATE Act's one-time 8 hours on substance use disorders for DEA registrants) is separate from the Board's rules.

Your first renewal

The Board says "newly licensed physicians are exempt from the CME requirement the first time they register." Its FAQ adds: "If your INITIAL registration cycle is less than 24 months, you are not required to complete CE prior to your first renewal." Initial permits are 12 or 24 months long, so check yours. The opioid hours due within one year of licensure and the human trafficking hour in the first renewal period still apply.

Exemptions and alternate compliance

• Board certification or recertification in the 36 months before renewal is presumed to satisfy most hours, for one registration (Occupations Code §156.052). The Board's chart says this covers ethics but not human trafficking, and "MIGHT" cover the opioid hours depending on the specialty board.
• Maintenance of Certification (ABMS MOC or AOA OCC), when it requires qualifying CME, also covers most hours.
• Residency or fellowship: physicians in training, or who finished within 6 months of renewal, meet the requirement through their program.
• Temporary exemptions for catastrophic illness, military service or residence outside the US for over a year, or good cause. Request them through CE Broker at least 30 days before renewal (§161.35(d)).
• Military service members get two extra years to finish CME (§161.31(a)). Officially retired physicians are exempt. Voluntary charity care physicians need 12 informal credits.

Reporting: CE Broker

From September 1, 2026, Texas law (SB 912, 2025) requires the Board to verify CE through a tracking system, and the Board uses only CE Broker. You must have an active CE Broker account (a Basic account is free) and report all completed coursework there before you renew: "Licensees without a 'Complete' status in CE Broker will be unable to access the TMB renewal system." Courses entered for another state's license do not carry over to your Texas license automatically. The Board does not want certificates sent with the renewal. §161.35 does not set a retention period, so keep certificates at least through your next registration period.

Checklist before you renew

1. Find your expiration date (February 28, May 31, August 31 or November 30) in MyTMB or the license lookup.
2. Make sure CE Broker shows 48 credits, at least 24 of them formal (AMA PRA Category 1, AAFP Prescribed or AOA Category 1-A).
3. Confirm 2 formal hours of ethics or professional responsibility.
4. If you practice direct patient care, check whether pain management/opioid hours or the human trafficking hour are due this period.
5. If you treat patients in an emergency room setting and your license expires on or after February 28, 2027, add 2 hours of task-force-approved forensic evidence collection. Otherwise, file the attestation in CE Broker.
6. If your license expires on or after May 30, 2027, add 1 hour of nutrition and metabolic health.
7. If you provide obstetric care, complete the Life of the Mother Act course in MyTMB once.
8. Renew before your expiration date.

Requirements change. This guide was checked against the sources below on October 6, 2026; confirm with the Board before you rely on it.