# Tennessee MedSpa Business Facts

## Executive Summary
Tennessee tightly restricts who can provide cosmetic medical services. It enforces a strict interpretation of the Corporate Practice of Medicine and uniquely features a formal "Medical Spa Registry" that dictates exactly who can serve as a Medical Director and what procedures can be offered.

**Difficulty Rating:** Hard

## 1. Ownership Rules & CPOM
- **The Core Rule:** Tennessee strictly enforces the Corporate Practice of Medicine (CPOM). Under state law, non-physicians are prohibited from owning a medical practice or employing physicians to practice medicine.
- **Corporate Structures:** A MedSpa offering medical aesthetic services must legally operate as a Professional Limited Liability Company (PLLC) or Professional Corporation (PC) owned exclusively by a Tennessee-licensed physician (or permitted combinations of licensed medical providers like NPs).
- **The MSO Model:** Entrepreneurs, marketers, and business managers who are not physicians must utilize the Management Services Organization (MSO) model. The MSO provides the commercial infrastructure and contracts with the physician-owned PLLC via a Management Services Agreement (MSA).
- **Fee-Splitting Prohibitions:** The MSO cannot be paid a percentage of the medical clinic’s patient revenue. Management fees must be established at a fair market value (FMV) flat rate or a cost-plus model to avoid violating Tennessee's anti-kickback statutes.

## 2. Everyday Clinical Operations & the Medical Spa Registry
- **Medical Spa Registry (The Essential TN Requirement):** Any facility acting as a medical spa in Tennessee MUST formally register with the Tennessee Board of Medical Examiners. 
- **Medical Director Qualifications:** The registered Medical Spa must have an active, TN-licensed physician serving as the Medical Director. Crucially, the Board expects the Medical Director to have documented training or board certification (e.g., dermatology, plastic surgery, or documented equivalent CME) directly relating to the cosmetic medical services being offered.
- **Laser Operations:** Firing a medical-grade laser alters human tissue and is the practice of medicine. In Tennessee, physicians may delegate the use of lasers only to specific licensed medical professionals (like RNs, PAs, NPs). Unlicensed personnel and standard estheticians are generally prohibited from operating medical lasers for cosmetic procedures.
- **Injectables:** The administration of Botox and dermal fillers is the practice of medicine. Physicians may delegate injections to an RN, NP, or PA under standing orders following an initial "good faith" exam. Delegation of neurotoxins or dermal fillers to unlicensed medical assistants or estheticians is strictly prohibited.

## 3. Key Challenges & Common Pitfalls
- **Registry Ignorance:** Opening a clinic offering Botox and lasers without filing for the formal Medical Spa Registry with the TN Board of Medical Examiners.
- **Underqualified Medical Director:** Hiring a Medical Director who has no documented background, CME, or board certification in aesthetic medicine, which can lead to rejected Medical Spa Registry applications.
- **Improper Delegation:** Specifically allowing estheticians or unlicensed laser techs to fire lasers, which violates Board delegation rules regarding tissue-altering devices.
- **Improper MSO Structure:** Drafting an MSO agreement where the non-physician exercises "clinical control" over the Medical Director's practice.

## 4. Timeline & Costs
- **Legal Setup:** Proper MSO agreements, professional entity formation, and clearing the Medical Spa Registry take time. Expect 3 to 6 months to establish the complete legal framework.
- **Costs:** Legal setup fees for establishing the MSO, PLLC structure, and registry paperwork typically range from $10,000 to $18,000.