How the Medicare Drug Price Reforms Are Reshaping Part DMedical spas, also called medi-spas or med spas, may offer the relaxing experiences associated with traditional spas, but they may also offer medical procedures more commonly associated with doctor’s offices and hospitals. For this reason, California and many other states have strict laws governing how medical spas must operate.
Key Takeaways
- Medical spa regulations vary widely by state, from strict physician-ownership requirements to more permissive rules for nurses and non-licensed owners.
- California treats medical spa procedures as the practice of medicine, requiring injections, lasers, and medical-grade skin treatments to be performed by a physician or a supervised nurse or PA.
- As of January 1, 2026, qualifying “104 NP” nurse practitioners can own and independently direct a California medical spa without physician supervision under AB-890 — a meaningful exception to the traditional ownership model.
- Patients have a right to know who is performing their procedure, the associated risks, and how complications will be handled.
- Many medical spa owners unknowingly operate illegal businesses simply by failing to meet state licensing and supervision requirements.
- Even a fully compliant medical spa carries real risk, making adequate malpractice and liability coverage essential regardless of how carefully the business is run.
State Laws on Medical Spas
Regulations on medical spas vary from state to state. State requirements may impact who can own a medical spa, who can provide medical spa services, and other relevant details.
Some states are quite strict, while others are relatively lax. For example, according to Dermascope, some states may require medical spa owners to be physicians, while other states may allow nurse practitioners, registered nurses, physician assistants, or even non-licensed individuals to have full or partial ownership.
California Requirements for Medi-Spas
California’s requirements for medical spas are considered stringent. According to the Medical Board of California, medical spas fall under the practice of medicine.
- Medical procedures – including the use of injections, lasers, and medical-level dermabrasion or skin peels – must be performed by a physician or by a registered nurse or physician assistant under the supervision of a physician.
- Medical spas that provide medical procedures must generally be owned by physicians (see the 2026 exception below).
- Patients should be fully informed. Specifically, they should know the qualifications of the person performing the procedure, the risks associated with the procedure, and how complications will be handled.
The Medical Board of California provides more frequently asked questions for cosmetic treatments.
A 2026 Exception: Nurse Practitioner-Owned Med Spas
Starting January 1, 2026, California created a narrow exception to the physician-ownership requirement under AB-890. Nurse practitioners who qualify for “104 NP” status — meaning they’ve practiced as a “103 NP” for at least three years and meet specific certification requirements — can now own and independently direct a medical spa without physician supervision. Most practicing NPs do not yet qualify for this designation, so physician ownership and supervision remain the standard for the large majority of California medical spas. Owners and directors should confirm current requirements with a healthcare attorney before relying on this exception.
Illegal Medical Spa Operations
Medical spa treatments can go dangerously wrong. There have been tragic news stories of people suffering severe medical complications after getting illicit injections, and the FDA has issued a warning about dangerous silicone injections that can result in pain, disfigurement, and even death.
Some back-alley treatments are clearly illegal and dangerous. However, not all infractions are so obvious. According to Dermatology Times, many medical spa owners may be unaware that they are operating illegal businesses. This can happen when the people involved fail to meet the state’s requirements for medical spas.
It’s not just unlicensed individuals who can run afoul of state laws, either. Medical professionals may also find themselves accused of operating illegal medical spas. In one example reported by Fresno Bee, a Department of Consumer Affairs investigator in California conducted undercover investigations involving a registered nurse who was accused of hosting Botox parties without a doctor’s supervision. A doctor was also accused of aiding and abetting the nurse.
Key Considerations
There is a significant demand for medical spa treatments and these businesses can be very profitable. However, to avoid problems, it’s important to consider key issues.
- What are the current state laws on medical spas? Watch for changes in regulations.
- If you will be providing medical spa services, do you meet the requirements in your state?
- If you will be the owner or partial owner of a medical spa, can you ensure that the spa will comply with all state laws?
- Does the medical spa have adequate insurance coverage in case something goes wrong? Even fully compliant medical spa procedures carry some risk. In our experience, this is where medical spa insurance gaps most often show up — a facility assumes its providers’ individual malpractice coverage extends to the business entity itself, when in most cases it doesn’t.
For more on how these coverages fit together, see our overview of common medi-spa insurance coverages.
Is Your Medi-Spa Properly Covered?
There is a significant demand for medical spa treatments, and these businesses can be very profitable — but even a fully compliant medical spa carries real risk. Heffernan’s Medical Spa Malpractice Insurance team can help make sure your ownership structure, providers, and facility are all properly insured. We only work with the best carriers, and we’re free to recommend the plans and options that are best for our clients, without any hidden agendas.
