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Gold Designated Practice Status

A pain management clinic is defined in statute and rule as a publicly or privately-owned facility for which a majority of patients are issued, on a monthly basis, a prescription for opioids, benzodiazepines, barbiturates, or carisoprodol, but not including suboxone.


A pain management clinic may not operate in Texas without obtaining a certificate from the Texas Medical Board (TMB).  Certain exemptions apply and can be found in Texas Occupations Code (TOC) §168.002.


A pain management clinic may now apply to be designated as a "Gold Designated Practice." Clinics that choose to apply for the “Gold Designated Practice” may be verified by an initial audit that is valid for five years.  Audits are non-disciplinary reviews and are conducted as an off-site document review.  


Once approved as a “Gold Designated Practice”, no further audits or inspections will be conducted during the clinic’s five-year "Gold Designated Practice" period, unless:

  •        a complaint is received or initiated by the Board concerning operation of the clinic or operators at the clinic;
  •        the clinic changes location; or
  •        the clinic's ownership structure changes to a majority of new owners.


In order to be eligible for a "Gold Designated Practice" status, one of the following must be true:

  •        If a clinic is exempt from PMC registration under TOC 168.002(7), the clinic must 
    • be operated by a majority of physicians who currently hold or previously held ABMS or AOA Board-certification or subspecialty certification in pain management, and
      • have a majority of physicians perform or properly supervise delegates in providing other forms of treatment besides qualifying pain management prescriptions to a majority of the patients at the clinic;
      • the clinic's providers utilize a Medical Home Agreement signed by the primary prescriber and the patient; or
      • have a written collaborative, coordinated care agreement or a memorandum of understanding with the patient's primary physician for treating and managing the patient


  •        If a clinic is currently certified by TMB as a Pain Management Clinic, the clinic must
    • be operated by physicians who currently hold or previously held an ABMS or AOA Board-certification or sub-specialty in pain management or hold a ABMS or AOA Board-certification in an area that is eligible for a pain management subspecialty, and
      • have a Medical Home Agreement signed by the primary prescriber and the patient; or
      • a written collaborative coordinated care agreement or memorandum of understanding providing that each physician who prescribes qualifying prescriptions will consult with a pain specialist for the patient.


To apply for the “Gold Designated Practice”, please complete the Pain Management Gold Designated Application Form and submit it along with the requested additional documentation:


  •        Medical Home Agreement – provide a copy of the Medical Home Agreement, written collaborative, coordinated care agreement or memorandum of understanding to provide management and treatments of pain, that describes measures that may be used for reduction of pain such as, but not limited to:
    • multimodal treatment such as surgery, injections, pain pumps, osteopathic manipulation, epidurals, trigger point injections, dry needling, and topical creams or patches;
    • multi-disciplinary practices such as medication assisted tapering and weaning, computer-based training pain coaching, acupuncture, chiropractic, physical therapy, massage, and exercise/movement; or
    • collaborative care or other behavioral health integration services such as evidenced-based cognitive behavioral therapy interventions for mental health and pain reduction, medication management and opioid weaning, patient-centered education, regular monitoring and assessments of clinical status using validated tools, assessment of treatment adherence, motivational interviewing, and a structured approach to improving the biopsychosocial aspects of pain management. 
  •        Board Certification - Copy of most recent Board certification for each operating physician


The completed attestation and all supporting documentation should be sent as one packet directly to the Texas Medical Board office via email to


Upon receipt of the request with the required documentation, TMB staff will evaluate the documentation and contact the clinic about the initial audit.


Pain Management Gold Designated Application Form 


Gold Designated Practice - Approved Clinics