Summary of TMB Rules for Reporting CME Activities

Physicians are required to complete 48 credits of continuing medical education every 24 months. At least half of these hours must be in formal, category I or 1A courses. A physician must report during registration if she or he has completed the required CME. 

Physician CME Requirements

24 Formal Category 1 or 1 A hours:

  • courses designated for AMA/PRA Category 1 credit by a CME sponsor accredited by ACCME (Accreditation Council for CME) or state medical society recognized by ACCME;
  • approved for credit by American Academy of Family Physicians;
  • designated for AOA Category 1-A credit; or
  • approved by TMA based on standards established by AMA for its Physician's Recognition Award.

Brochures or promotional materials for CME activities and self instructional courses or materials will carry a specific statement advising physicians if the activity has been approved for any of the above types of credit.  

Medical Ethics and/or Professional Responsibility

At least 2 of the 24 formal hours must involve the study of medical ethics and/or professional responsibility. Professional responsibility includes but is not limited to courses in: Risk management, Domestic Abuse; or Child Abuse. Formal courses must be approved for ethics or professional responsibility credit by the accrediting agency.  

Pain Management and the Prescription of Opioids

  • At least 2 of the 24 formal hours must involve the study of the following topics: 
    • best practices, alternative treatment options, and multi-modal approaches to pain management that may include physical therapy, psychotherapy, and other treatments;
    • safe and effective pain management related to the prescription of opioids and other controlled substances, including education regarding:
      • standards of care;
      • identification of drug-seeking behavior in patients; and
      • effectively communicating with patients regarding the prescription of an opioid or other controlled substances; and 
    • prescribing and monitoring of controlled substances.  
  • These formal hours maybe credited towards
    • the requirements for medical ethics or professional responsibility for any physician, or
    • the 10 hours of pain management continuing education required for those physicians practicing in pain clinics. 
  • This requirement applies to the renewal of a license on or after September 1, 2020.

Human Trafficking

  • As part of the 24 formal hrs required, a course in human trafficking prevention must be completed.
  • The course must be approved by HHSC, and
  • The course maybe credited towards the requirements for medical ethics or professional responsibility for any physician.
  • See HHSC's Health Care Practitioner Human Trafficking Training page to access the free course that satisfies these requirements, and for more information about this requirement.
  • This requirement applies to the renewal of a license on or after September 1, 2020.

Documentation of Formal Activities

Documentation of attendance at formal CME activities can be obtained from the provider of the activity in the form of a CME reporting form, attendance certificate, CME transcript or letter of verification of attendance.

Documentation to verify attendance should not be submitted to the Texas Medical Board with the application for registration. Documentation, however, should be retained by the physician for reference in reporting CME hours completed and in the event that verification is requested by the board in a random audit of compliance.

Informal Activities 

Physicians may complete up to 24 credits (of the required total 48 hours every 24 months) by participating in informal CME activities. The following may be reported as informal credits:

  • Conferences, seminars, grand rounds, case conferences, journal clubs, etc. not designated for formal credit. Record activity title; date; and clock hours expended.
  • Self-instructional materials or courses not designated for formal credit and self-assessment examinations and reviews. Record activity/course title; date of use; and clock hours expended.
  • Reading clinically relevant medical journals or articles and use of literature search databases in connection with the provision of patient care. Record name of publication or data base utilized; date read/used; clock hours expended.
  • Participation in patient care review activities (peer review or hospital quality of care review committees).
  • Research/preparation time for medical presentations delivered to health professionals.
  • Up to 10 hours may be claimed for: publication of a medical or medically related article; for each chapter of a medical or medically related book or other medical education materials; preparation of an exhibit displayed at a scientific medical meeting or other CME activity.  Articles must be published in a recognized medical journal that is primarily read by physicians or other health professionals. Credit may be claimed only once for publications or exhibits even if it is reissued in a changed format. Record the type of activity; date completed; and clock hours expended.
  • Up to 6 hours may be claimed for volunteer services at a site serving medically underserved populations, as defined in the Medical Practice Act.  The volunteer hours should be at a site other than the physician's primary practice location.

Informal activities are not always provider verifiable. If available, physicians should retain transcripts or certificates of attendance. If not available, the attached log sheet may assist in maintaining a personal record which could easily be submitted to the Texas Medical Board if requested.  

Excess Hours Carried Forward

Excess formal or informal credits earned in one 24-month period may be applied toward the registration period's requirements. A maximum of 48 excess credits may be carried forward and these credits must be applied within two years following the date of the registration period during which they were earned. A licensee under a two-year license period may apply up to 24 CME hours retroactively to the preceding year's annual requirement.  These hours may be counted only toward one registration period.

Presumed Compliance

A physician will be presumed to have complied with the CME requirement if in the preceding 36 months he/she becomes board certified or recertified in a medical specialty. The TMB has determined that the activities undertaken to become boarded or recertified exempt the physician from all CME requirements. This exemption is valid for one registration period only. Physicians in residency/fellowship training or who have completed such training within six months prior to the license expiration date will satisfy the formal and informal CME requirements by their residency or fellowship program.

Retired Physicians 

Retired physicians "on official retired status" with the Texas Medical Board will not be required to report CME activities. Physicians who are retired from practice but wish to retain an active license must meet the CME requirement.


Exemption Request 

Exemptions are subject to the approval of the executive director of the Texas Medical Board and must be requested in writing at least 30 days prior to the expiration date of the license.

An exemption may be requested for the following reasons:

  1. catastrophic illness
  2. military service of longer than one year's duration outside Texas
  3. medical practice and residence of longer than one year's duration outside the U.S.
  4. good cause on written application of the licensee that gives satisfactory evidence to the board why the physician is not able to comply


Failure to obtain and report 48 credits of CME every 24 months at the time of license renewal will result in nonrenewal of the license until the physician obtains and reports the required CME hours. However, the executive director of the board may issue a temporary license for a period of up to 30 days to the physician who has not complied with the CME requirement. Note that this 30 day extension through the temporary license is at the discretion of the executive director and is not an automatic grace period. The temporary license not only allows the board time to verify the accuracy of information related to the physician's CME hours, but also allows the physician an opportunity to correct any deficiency so as not to terminate ongoing patient care. CME credits which are obtained during the 30 day grace period after the expiration of the licensee's permit to comply with the CME requirements for the preceding two years, shall first be credited to meet the CME requirements for the previous registration period and then any additional credits obtained shall be credited to meet the CME requirements for the current registration period.
Failure to comply with the CME requirement for renewal of a license invokes the monetary penalty for late registration and may invoke Administrative Penalties as determined by the Disciplinary Process Review Committee of the board.  A false report or statement to the board regarding CME hours is basis for disciplinary action by the board.

Log Sheet

This log sheet may be reproduced by the physician as needed. Additional copies also are available from the Texas Medical Association's continuing medical education office.

Texas Medical Board Rules (full text)  

Last Updated On

July 21, 2022

Originally Published On

March 23, 2010