Texas CME Requirements for Physicians: 2026 Guide

Texas CME requirements for physicians come down to 48 credits every two years, with half of them formal and several topics the Texas Medical Board names specifically. Here is what the Board requires and what changed in September 2026.

We checked these requirements against the Texas Medical Board’s website and the Texas Administrative Code. Rules change, so confirm with the Texas Medical Board before your renewal. For other states, see our CME requirements by state guide.

The short answer

You need 48 CME credits every 24 months, tied to your registration period rather than the calendar year.
At least 24 of those credits must be formal AMA PRA Category 1 Credit™ (or the other formal categories the Board accepts), and up to 24 can be informal.
Within the formal hours you need 2 hours of medical ethics and/or professional responsibility and an approved human trafficking prevention course.
Physicians in direct patient care also need 2 hours on pain management and opioid prescribing within one year of licensure, again at the second renewal, and then every 8 years.
Amendments effective September 3, 2026 add 2 credits on forensic evidence collection and 1 credit on nutrition and metabolic health.
Ethics and opioid hours can’t be carried forward, and you don’t send documentation with your renewal unless you’re audited.

Texas CME requirements at a glance

Requirement	What the Board asks for	Can it carry forward?
Total credits	48 credits per 24-month registration period	Up to 48 excess credits, to the next registration period
Formal credits	At least 24 (Category 1 or 1-A from accepted sponsors)	Yes, except the required topics below
Informal credits	Up to 24 (self-study, hospital lectures, grand rounds, case conferences)	Yes
Ethics and/or professional responsibility	2 formal hours each biennium	No
Pain management and opioid prescribing	2 formal hours within 1 year of licensure, again at the second renewal, then every 8 years (direct patient care)	No
Human trafficking prevention	An HHSC-approved course, counted within the formal hours	No (it is a required formal credit under the rule)
Forensic evidence collection	2 credits (formal or informal), effective September 3, 2026	Confirm with the Board
Nutrition and metabolic health	1 credit (formal or informal), effective September 3, 2026	Confirm with the Board

Total hours and the renewal cycle

Texas physicians must complete 48 CME credits every 24 months. The Board ties that window to your biennial registration period, so count your hours from your own renewal dates, not January to December.

Newly licensed physicians are exempt the first time they register. After that, you attest to your CME at renewal without submitting certificates.

Formal vs. informal hours

At least 24 of the 48 credits must be formal. The Board accepts AMA PRA Category 1 Credit™ from ACCME-accredited sponsors or ACCME-recognized state medical societies, along with AAFP-approved credit, AOA Category 1-A credit, and courses approved by the Texas Medical Association. If you want a refresher on what Category 1 means, our AMA PRA Category 1 Credit™ explainer covers it.

The remaining credits can be informal. The rule lists self-study and attendance at hospital lectures, grand rounds, and case conferences that aren’t approved for formal credit. Keep a log of informal hours you can send the Board if asked.

Medical ethics and professional responsibility

You need at least 2 formal hours in medical ethics and/or professional responsibility each biennium. The Board gives risk management, domestic abuse, and child abuse as examples.

The course has to be approved for ethics or professional responsibility credit by its accrediting agency. The Board stopped designating ethics courses itself in October 2016, but the 2-hour requirement stayed in place.

Pain management and opioid prescribing

If you practice direct patient care, 2 of your formal hours must cover alternative and multimodal pain treatment and the safe prescribing of opioids and other controlled substances. The Board’s schedule is within one year of licensure, again as part of your second renewal, and then every 8 years (every fourth renewal). The Board lists standards of care, recognizing drug-seeking behavior, patient communication, and prescribing and monitoring as the topics involved.

These hours may also count toward the ethics/professional responsibility requirement, and toward the 10-hour pain management CME that applies to pain clinic personnel.

Physicians who work in or direct a pain management clinic have an added obligation. Under Board rule, the clinic’s medical director must make sure personnel complete 10 hours of pain management CME. Check the Board’s rule for the exact interval, since its two CME pages describe it differently.

Human trafficking prevention course

Texas requires a human trafficking prevention course approved by the Texas Health and Human Services Commission (HHSC), completed as part of your 24 formal hours. HHSC offers a free option on its Health Care Practitioner Human Trafficking Training page, and the course can count toward the ethics/professional responsibility requirement.

The Board also describes a timing rule from Senate Bill 415 (2023). Physicians must complete at least 1 hour on identifying and assisting trafficked persons in their first renewal period after licensure, then at least 1 hour every third renewal period after that. Confirm with the Board which renewal periods apply to you.

New for 2026: forensic evidence and nutrition credits

Amendments to 22 TAC §161.35 took effect September 3, 2026. They implement House Bill 47 and Senate Bill 25 (89th Legislature) and add two requirements you can meet with formal or informal credit.

Two credits on forensic evidence collection. The Board will recognize any course the Governor’s Sexual Assault Survivors’ Task Force finds acceptable.
One credit on nutrition and metabolic health, focused on guidelines recommended by the Texas Nutrition Advisory Committee.

Whether these apply to every physician isn’t settled in the rule text. When a specialty society asked the Board to clarify that non-emergency physicians are exempt, the Board declined, saying it doesn’t track practice designation. It said licensees whose practice doesn’t require a statutory topic can claim an exemption through attestation in CE Broker, the same way it has handled the opioid and human trafficking requirements.

Separately, the Board says physicians who perform forensic exams on sexual assault survivors must have basic forensic evidence collection training, and those who treat patients in an emergency room setting may meet it with 2 hours of CME on forensic evidence.

Other requirements for specific roles

Some requirements only apply if your practice includes certain work. EMS off-line medical directors must complete 12 formal hours in EMS medical direction (or hold qualifying EMS certification, or complete a DSHS-approved course) within two years of notifying the Board, then 1 formal hour each biennium after that.

Physicians who treat tick-borne diseases are encouraged, but not required, to take formal CME on them.

Carryover, exemptions, and audits

Up to 48 excess credits can be carried forward to the next registration period. The required formal topics (ethics, opioid prescribing, and human trafficking under the current rule) cannot be carried forward and must be completed in the registration period when they are due. If you come up short, the rule allows a deficiency to be fixed within 30 days after your renewal is due.

Several groups are presumed compliant or exempt. Physicians certified or recertified by a qualifying specialty board within the preceding 36 months are exempt for one registration. Physicians meeting ABMS MOC or AOA OCC requirements are presumed to meet the formal and informal hour totals but still owe the ethics, opioid, and human trafficking topics. Residents, fellows, and those who finished training within six months are covered by their program, except for the opioid and human trafficking topics.

Retired physicians are exempt, and voluntary charity care status cuts the requirement to 12 informal credits. Other exemption requests go to the Board in writing at least 30 days before renewal is due. The Board runs random audits after registration periods, so keep your certificates and informal logs where you can find them.

Planning your Texas CME

Most of the 24 formal hours are yours to choose, so many physicians fill them with self-study in their own specialty. Travel Medical Seminars offers Audio-Digest courses in a 10-credit short course and a 20-credit full course, each designated for AMA PRA Category 1 Credit™ by the Lippincott Continuing Medical Education Institute, which is accredited by the ACCME. You study at your own pace and complete testing online. Browse all courses, or look at the pain management titles, and check each program’s materials to see whether it is approved for a specific Texas topic requirement.

Texas CME requirements for physicians (2026 guide)