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Texas CME requirements 2026 rules for physicians, NPs, PAs, CRNAs and CAAs
Texas regulates five clinician professions through different boards, each with its own continuing-education rules: physicians (MD/DO), nurse practitioners (APRN/NP), physician assistants (PA), nurse anesthetists (CRNA) and anesthesiologist assistants (CAA), who practice here under an anesthesiologist's delegation. Below, each profession's total hours, mandated topics, opioid/controlled-substance rule, and tracking, plus the one federal rule they share. Physician rules reviewed October 13, 2026.
Physicians (MD / DO)
Set by the Texas Medical Board. Verified October 13, 2026.
General CME: 48 hours every 2 years (minimum 24 Category 1).
Opioid / controlled substance
At least 2 hours, safe/effective pain management re: prescribing opioids & other CS. First two renewal periods, then at least every 8 years. Trigger: renewals designating direct patient care.
✓ No board pre-approval needed: any ACCME AMA PRA Category 1 course covering §156.055 content counts. CE Broker reporting has been mandatory since September 1, 2026 (SB 912): renewal will not open without a CE Broker 'Complete' status.
All mandated CME topics
| Topic | Hours | Timing | Applies to |
|---|---|---|---|
| Medical ethics and professional responsibility (includes risk management, domestic abuse and child abuse) | 2 | per biennium | all |
| Controlled substances / opioid / pain management | 2 | first 2 renewal periods, then at least every 8 years | physicians in direct patient care (non-direct-care may waive) |
| Human trafficking prevention (standalone, HHSC-approved) | 1 | 1st renewal then every 3rd renewal | physicians in direct patient care |
| Pain management clinic CME | 10 | biennial (per 22 TAC 172.3(d)(2)) | pain-clinic directors/personnel |
| Nutrition and metabolic health | 1 | every renewal, for licenses expiring on or after May 30, 2027 | all physicians (Tex. Occ. Code §156.061; 22 TAC 161.35) |
| Laws governing pregnancy-related medical emergencies (TMB's own free course, via MyTMB) | 1 | one-time (before first renewal after 1/1/2026) | physicians providing obstetric care |
| Forensic evidence collection / sexual assault survivor care (HB 47): SASTF-approved courses only | 2 | per 2-year cycle, beginning with licenses expiring 2/28/2027 (no approved coursework yet) | any physician treating patients in an ER or urgent-care setting, practice setting, not specialty; attest out via CE Broker if this isn't you |
| EMS (off-line) medical direction | 12 initial, then 1 per renewal | 12 hours within 2 years of notifying the Board (or ABMS EMS board certification / AOA CAQ / a DSHS-approved course), then 1 hour each biennial renewal (Board rule 169.12) | off-line EMS medical directors |
Citation: Tex. Occ. Code ch. 156; TMB Board rule 161.35
Nurse Practitioners (APRN / NP)
Set by the Texas Board of Nursing, separate from the physician rules above, with its own hours and topics. Verified October 19, 2026.
General CE: 20 contact hours of CNE applicable to the APRN's area of practice per licensing period, or maintenance of national certification in role/population focus (22 TAC 216.3(a)-(c)).
Opioid / controlled substance
2 hours, every year, for holders of controlled-substance prescriptive authority. Timing is built into the free multi-state planner.
All mandated CE topics
| Topic | Hours | Timing | Applies to |
|---|---|---|---|
| Pharmacology / pharmacotherapeutics (prescriptive authority) | 5 | per cycle | prescribers |
| Opioid / controlled-substance prescribing | 2 | Annually (per rule text), i.e., at minimum 2 hours regarding safe and effective pain management each year the authority is held; effectively covered each 2-year renewal cycle. A separate 1 contact hour annually on best practices/alternatives/multi-modal pain management also applies to opioid prescribers (22 TAC 216.3(c)(5)). | APRNs whose prescriptive authority agreement authorizes prescribing opioids and other controlled substances (i.e., prescribers of opioids/controlled substances). APRNs without opioid/CS prescriptive authority are not subject. |
| Best practices / alternatives / multi-modal approaches to pain management | 1 | every year (22 TAC 216.3(c)(5)) | APRNs whose prescriptive authority includes opioids |
| Human trafficking prevention (HHSC-approved course) | 1 | Each renewal (on/after 9/1/2020) | All nurses (RN/APRN) providing direct patient care |
| Older adult / geriatric populations | 2 | Per licensing period | Nurses whose practice includes older adult/geriatric populations |
| Nursing jurisprudence and ethics | 2 | Every third 2-year licensing period | All nurses (RN/APRN) |
| Forensic evidence collection | 2 | One-time (within 2 years of employment) | Nurses working in an emergency department setting / performing sexual assault exams |
| Nutrition & metabolic health Rule pending | To be set by Board rule | Renewals on or after January 1, 2027; the Board of Nursing rule is due by December 31, 2026 | All Board of Nursing licensees, APRNs included (Tex. Occ. Code 301.309, SB 25) |
Tracking: Self-report / audit-based. Nurses retain CE completion certificates and are subject to random the Board of Nursing audit; renewal is via the Texas Nurse Portal (Nursys). The Board of Nursing does not use CE Broker. Per secondary reporting, effective 9/1/2026 nurses may need to upload completion certificates to the Texas Nurse Portal to verify the required hours at renewal (verify with the Board of Nursing before relying).
Physician Assistants (PA)
Set by the Texas Physician Assistant Board (administered under the Texas Medical Board), separate from the physician rules above, with its own hours and topics. Verified October 19, 2026.
General CE: At least 20 credit hours must be formal Category I CME from an approved CME sponsor (e.g., AAPA/AMA PRA); the remaining 20 may be Category II (self-study, hospital lectures/grand rounds, case conferences). (22 TAC 185.4.)
Opioid / controlled substance
2 hours, every 2 years, for holders of controlled-substance prescriptive authority. Timing is built into the free multi-state planner.
All mandated CE topics
| Topic | Hours | Timing | Applies to |
|---|---|---|---|
| Opioid / controlled-substance prescribing | 2 | At least 2 hours each renewal cycle (per 24-month biennium); counts toward the 40-hour total and toward Category I. | PAs engaged in direct patient care who (1) prescribe, order, or administer opioids or other controlled substances, or (2) hold an active DEA registration. PAs meeting none of these criteria may claim an exemption. |
| Human trafficking prevention (HHSC-approved course) | 1 | Prior to each renewal (renewals on/after 9/1/2020) | All physician assistants |
| Forensic evidence collection | 2 | Starts with licenses expiring on February 28, 2027 | PAs whose practice includes treating patients in an emergency room or urgent-care setting (HB 47). Only courses approved by the Governor's Sexual Assault Survivors' Task Force (SASTF) count. |
| Nutrition & metabolic health | 1 | each 2-year cycle, renewals on or after January 1, 2027 (22 TAC 183.16(a)(2)(B)) | All PAs (Tex. Occ. Code 204.1563) |
Tracking: Texas Medical Board partners with CE Broker for CE tracking. Per TMB rulemaking and secondary reporting, mandatory CE Broker verification for TMB licensees (physicians and other TMB practitioners, including physician assistants) takes effect 9/1/2026: completed CE must be logged/verified in CE Broker before renewal. Confirm PA scope directly with TMB, as the 9/1/2026 mandate has been most explicitly described for physicians.
Nurse Anesthetists (CRNA)
Set by the Texas Board of Nursing, separate from the physician rules above, with its own hours and topics. Verified October 19, 2026.
General CE: 22 TAC 216.3(c): 'A nurse licensed by the Board as an APRN is required to complete 20 contact hours of continuing education or achieve, maintain, or renew the national nursing certification recognized by the Board as meeting the certification requirement for the APRN's role and population focus area of licensure within the licensing period.' The underlying RN 20-hour requirement (216.3(a)) is satisfied by the same hours/certification. Topics that reach all nurses incl. APRNs: human trafficking prevention course each renewal (216.3(i)); 2 hours nursing jurisprudence and ethics every third 2-yr period (216.3(g)); 2 hours older-adult/geriatric if practice includes that population (216.3(h)); forensic evidence collection 2 hours for ED nurses (216.3(d)). Rule last amended 11/19/2019.
NBCRNA recertification is accepted in place of state CE. Maintaining NBCRNA certification (board-recognized for the CRNA role) satisfies the 20-hour requirement in full. It does not satisfy the separately mandated topics (human trafficking course each renewal; jurisprudence/ethics; older adult; forensic) nor the +5 pharmacotherapeutics for prescriptive-authority holders. National layer: NBCRNA continued certification (4-year cycle: 60 Class A + 40 Class B credits, MAC Check).
Opioid / controlled substance
2 hours, every year, for CRNAs who hold controlled-substance registration. Timing is built into the free multi-state planner.
All mandated CE topics
| Topic | Hours | Timing | Applies to |
|---|---|---|---|
| Human trafficking prevention (HHSC-approved course) | 1 | per cycle (each renewal) | All nurses incl. CRNAs providing direct patient care |
| Nursing jurisprudence and ethics | 2 | every third 2-yr licensing period | All nurses incl. CRNAs |
| Older adult / geriatric populations | 2 | per cycle | CRNAs whose practice includes older adult/geriatric patients (most anesthesia practices) - or maintain relevant certification |
| Forensic evidence collection | 2 | one-time (within 2 years of ED employment) | Nurses working in an emergency department setting - rarely CRNAs |
| Pharmacotherapeutics | 5 | per cycle | Only CRNAs holding prescriptive authority (22 TAC Chapter 222) - CRNAs who select/obtain/administer under Occupations Code 157.058 without a prescriptive authority number owe nothing |
| Opioid / controlled-substance prescribing (safe and effective pain management) | 2 | annually (plus a one-time 2-hour PMP course) | Only CRNAs whose prescriptive authority agreement covers controlled substances - not the typical CRNA practicing under 157.058 select/administer authority |
| Best practices / alternatives / multi-modal approaches to pain management | 1 | every year (22 TAC 216.3(c)(5)) | Only CRNAs whose prescriptive authority covers opioids |
| Nutrition & metabolic health Rule pending | To be set by Board rule | Renewals on or after January 1, 2027; the Board of Nursing rule is due by December 31, 2026 | All Board of Nursing licensees, CRNAs included (Tex. Occ. Code 301.309, SB 25) |
Tracking: Self-report/attestation via Texas Nurse Portal with random the Board of Nursing audit; retain certificates. The Board of Nursing does not currently use CE Broker; secondary reports indicate certificate upload/CE tracking changes effective 9/1/2026 - verify with the Board of Nursing.
Anesthesiologist Assistants (CAA)
Set by the Texas Medical Board (via physician delegation authority; no AA license issued), separate from the physician rules above, with its own hours and topics. Practice pathway: physician delegation. No state CAA license exists; you practice under an anesthesiologist's delegation and the state imposes no CE of its own. Verified August 24, 2026.
General CE: Texas has no AA licensure; CAAs work under an anesthesiologist's delegation per Occ. Code § 157.001 (physician may delegate a medical act to a qualified and properly trained person under supervision if it can be properly and safely performed, is performed in the customary manner and is not prohibited by other statute). There is therefore no state CME cycle; NCCAA certification maintenance is the de facto standard.
NCCAA recertification is accepted in place of state CE. Not a state rule; NCCAA certification is the practical qualification evidence for delegation ('qualified and properly trained person'). National layer: NCCAA certification (50 CME hours every 2 years, 40 anesthesia + 10 general, plus the CDQ exam).
Opioid / controlled substance
No standalone state opioid/controlled-substance CE mandate identified for this profession. The federal DEA MATE Act (one-time 8-hour training) still applies if you hold a DEA registration.
All mandated CE topics
No additional mandated topics identified beyond the total above.
Tracking: None at state level; employer credentialing of NCCAA status.
Federal: DEA MATE Act (all professions)
One rule is the same for every profession on this page. Every DEA-registered prescriber (physicians, nurse practitioners, physician assistants, and any CRNA or CAA who holds a DEA registration) must complete a one-time 8-hour training on treating patients with opioid or other substance use disorders, as a condition of DEA registration/renewal (since June 27, 2023). It is federal and applies in every state, and it does not replace Texas's recurring opioid/controlled-substance CME. A MATE-qualifying accredited course will usually still count toward your state general CME/CE total. How the MATE Act differs from state rules
Authority: MATE Act §1263, Consolidated Appropriations Act 2023 (21 U.S.C. §823).
Notes (physician data)
- (1) Opioid and controlled-substance CME: 2 hours within the first year of licensure and at the second renewal, then at least every 8 years (Occ. Code 156.055), for physicians in direct patient care. (2) Pain-clinic CME: 10 hours every 2 years (22 TAC 172.3(d)(2)). (3) Nutrition and metabolic health: 1 hour at every renewal for licenses expiring on or after May 30, 2027 (Tex. Occ. Code §156.061; 22 TAC 161.35).
- Since September 1, 2026, the Texas Medical Board's renewal system will not open until your CE Broker account shows 'Complete' with all of your CE reported (a free basic account is enough). A rule (22 TAC 161.35(c)(1)) still lets a CME shortfall be cured within 30 days after the renewal date; TMB has not reconciled the two, so report everything before you renew.
Common questions about Texas CME
How many CME hours does Texas require for physicians?
Texas requires 48 / 2 years (24 formal Category 1) of continuing medical education (Tex. Occ. Code ch. 156; TMB Board rule 161.35). 48 hours every 2 years (minimum 24 Category 1).
Does Texas require opioid or controlled-substance CME?
Yes. At least 2 hours, safe/effective pain management re: prescribing opioids & other CS. First two renewal periods, then at least every 8 years. Trigger: renewals designating direct patient care.
Does my opioid CME course need Texas board approval?
No board pre-approval: any ACCME AMA PRA Category 1 course covering §156.055 content counts. CE Broker reporting has been mandatory since 2026-09-01 (SB 912): renewal will not open without a CE Broker 'Complete' status.
How is CME tracked in Texas?
Texas tracking: CE Broker (required since 2026-09-01). Board: Texas Medical Board.
Do nurse practitioners and physician assistants have different CME requirements in Texas?
Yes. In Texas, nurse practitioners (APRNs) are licensed by the board of nursing and physician assistants (PAs) by the PA/medical board, each setting its own CE hours and mandated topics. These differ from the physician (MD/DO) figures. The federal DEA MATE Act and most state opioid/controlled-substance prescribing CME still apply to APRNs and PAs who hold a DEA registration. See the profession-specific sections on this page.
What are the CME requirements for CRNAs and anesthesiologist assistants in Texas?
CRNAs in Texas are regulated by the Texas Board of Nursing and must also maintain NBCRNA certification (a 4-year cycle of 60 Class A and 40 Class B credits). Certified anesthesiologist assistants are regulated by the Texas Medical Board (via physician delegation authority; no AA license issued) and maintain NCCAA certification (50 CME hours every 2 years plus the CDQ exam). Whether the state accepts national recertification in place of counted hours is stated in each section on this page.
More on Texas
- CME in Texas by specialty: anesthesiology, psychiatry, radiology, internal medicine, family medicine, emergency medicine
- Texas medical license renewal checklist: CME, fingerprints, lawful presence, PMP and DEA
- What a Texas license costs, and how long the board says it takes
- What else can hold up a renewal: PDMP accounts, fingerprints, lawful presence
- Licensed in more than one state? How one course can count in several
- Adding a state through the Interstate Medical Licensure Compact
- Track Texas CME next to your other licenses
Every license, certificate and renewal date on one list, checked against each board’s own rules, with a reminder before anything is due. 30 days free with a card on file. Licensed in more than one state? The free planner times your opioid and controlled-substance hours so one course counts in as many states as it can.
This page summarizes Texas board rules and statutes as of October 13, 2026 for five separately-regulated professions: physicians (MD/DO), nurse practitioners (APRNs), physician assistants (PAs), nurse anesthetists (CRNAs), and anesthesiologist assistants (CAAs). Each is governed by its own board and its hour totals and mandated topics differ. Never assume one profession's figures apply to another. Physician data is compiled from FSMB and state medical-board sources; APRN/PA data was validated against nursing- and PA/medical-board rules on July 20, 2026, with the opioid/controlled-substance timing structured on July 23, 2026; CRNA and CAA data was researched against nursing-board, medical-board and practice-act primary sources on August 24, 2026 (items the research could not pin to a primary source are marked “Confirm with the board”). This is educational information, not legal advice. Always verify current requirements with your own board before relying on them.