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Texas CME Requirements (2026): Physicians, NPs, PAs, CRNAs & 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, in the states that license them). Below, each profession's total hours, mandated topics, opioid/controlled-substance rule, and tracking, plus the one federal rule they share. Last reviewed 2026-08-24.
Physicians (MD / DO)
Set by the Texas Medical Board.
General CME: 48 hours every 2 years (minimum 24 Category 1).
Opioid / controlled substance
≥2 hours — safe/effective pain management re: prescribing opioids & other CS. First two renewal periods, then ≥ every 8 years. Trigger: renewals designating direct patient care.
✓ No board pre-approval gate: No board pre-approval — any ACCME AMA PRA Category 1 course covering §156.055 content counts. CE Broker reporting becomes MANDATORY 2026-09-01 (SB 912) — hard-stop renewal model.
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 >= 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 | all |
| Pain management clinic CME | 10 | biennial (per 22 TAC 172.3(d)(2)) | pain-clinic directors/personnel |
| Nutrition & metabolic health [PENDING] | TBD (pending TMB rule) | pending - effective 1/1/2027 (SB 25) | physicians (SB 25; TMB rule due 12/31/2026) |
| Laws governing pregnancy-related medical emergencies | 1 | one-time (before first renewal after 1/1/2026) | physicians providing obstetric care |
| Forensic evidence collection / sexual assault survivor care | 2 | per 2-year cycle (renewals filed on/after 9/1/2026) | 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 |
Citation: Tex. Occ. Code §156.051 (TMB CME rules 22 TAC ch. 166)
Nurse Practitioners (APRN / NP)
Set by the Texas Board of Nursing (BON) — separate from the physician rules above, with its own hours and topics.
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. |
| 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 |
Tracking: Self-report / audit-based. Nurses retain CE completion certificates and are subject to random BON audit; renewal is via the Texas Nurse Portal (Nursys). BON 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 BON 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.
General CE: At least 20 credits 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 |
| Nutrition & metabolic health [PENDING] | TBD (pending TMB rule) | Pending — renewals on/after 1/1/2027 | PAs (Tex. Occ. Code 204.1563). Hour figure is set by TMB rule, not statute. |
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 (BON) — separate from the physician rules above, with its own hours and topics.
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-hr 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 hrs nursing jurisprudence and ethics every third 2-yr period (216.3(g)); 2 hrs older-adult/geriatric if practice includes that population (216.3(h)); forensic evidence collection 2 hrs for ED nurses (216.3(d)). Rule last amended 11/19/2019.
NBCRNA recertification is accepted in place of state CE. Maintaining NBCRNA certification (BON-recognized for the CRNA role) satisfies the 20-hr 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 holders of controlled-substance prescriptive authority. 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 yrs 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 1 hr/yr best practices/multimodal pain and a one-time 2-hr PMP course) | Only CRNAs whose prescriptive authority agreement covers controlled substances - not the typical CRNA practicing under 157.058 select/administer authority |
Tracking: Self-report/attestation via Texas Nurse Portal with random BON audit; retain certificates. BON does not currently use CE Broker; secondary reports indicate certificate upload/CE tracking changes effective 9/1/2026 - verify with BON.
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.
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 everyone below. 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, applies in every state, and 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)
- Verified 2026-07-16: (1) opioid/CS CME = 2 hours within year 1 of licensure + at 2nd renewal, then >= every 8 years (Occ. Code 156.055), physicians in direct patient care - FSMB was right, our 'biennial/all' was wrong; (2) pain-clinic CME = 10 hours biennial (22 TAC 172.3(d)(2)), FSMB 'annual' wrong; (3) nutrition (SB 25) is real but effective 1/1/2027 with hours TBD by TMB rule - NOT 1 hour / 9-1-2025.
Pick your profession and all your states in the free planner and get one 5-year schedule that batches your opioid/controlled-substance CME so a single course covers as many licenses as possible.
Build my multi-state CME plan →This page summarizes Texas board rules and statutes as of 2026-08-24 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 2026-07-20, with the opioid/controlled-substance timing structured on 2026-07-23; CRNA and CAA data was researched against nursing-board, medical-board and practice-act primary sources on 2026-08-24 (items the research could not pin to a primary source are flagged [VERIFY]). This is educational information, not legal advice — always verify current requirements with your own board before relying on them.